Healthcare Provider Details

I. General information

NPI: 1669305140
Provider Name (Legal Business Name): SEA GLASS PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 GOVERNMENT ST STE I-2C
OCEAN SPRINGS MS
39564-3954
US

IV. Provider business mailing address

2113 GOVERNMENT ST STE I-2C
OCEAN SPRINGS MS
39564-3954
US

V. Phone/Fax

Practice location:
  • Phone: 251-865-7445
  • Fax:
Mailing address:
  • Phone: 251-865-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH RUEFF
Title or Position: OWNER/LPC
Credential:
Phone: 228-382-2217