MEDICARE: SEA GLASS PSYCHOTHERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1669305140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA GLASS PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	2113 GOVERNMENT ST STE I-2C
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3954
Country	:	US
Telephone Number	:	251-865-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 GOVERNMENT ST STE I-2C
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3954
Country	:	US
Telephone Number	:	251-865-7445
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LPC
Name	:	ELIZABETH RUEFF
Credential	:
Telephone Number	:	228-382-2217

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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