=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205214483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY RUHA KELLER LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2015
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3179 INDEPENDENCE DR
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94551-7595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-290-0036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 659 EDWARDS RIDGE RD
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27517-8780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-929-1171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 10821
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------