Provider Demographics
NPI:1013168442
Name:TRUAX, ELIZABETH LEANNE (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEANNE
Last Name:TRUAX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DAVIDSON MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:AR
Mailing Address - Zip Code:72055-0621
Mailing Address - Country:US
Mailing Address - Phone:870-370-0316
Mailing Address - Fax:
Practice Address - Street 1:8 CADILLAC DR STE 230
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5392
Practice Address - Country:US
Practice Address - Phone:615-647-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1201005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid