MEDICARE: MISS ELIZABETH C O'SICKY LPCC-S

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	101YM0800X	Mental Health Counselor	E.1700441-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265801278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH C O'SICKY LPCC-S

Provider Business Mailing Address
First Line	:	1865 N RIDGE RD E STE A
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 N RIDGE RD E STE A
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3359
Country	:	US
Telephone Number	:	440-324-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2015
Last Update Date	:	10/25/2019

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