MEDICARE: CARMELISA MINDRUM LPC

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	C.2103340	OH

General Provider Information

NPI Number	:	1851939524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELISA MINDRUM LPC

Provider Business Mailing Address
First Line	:	7147 ENGLISH DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-3137
Country	:	US
Telephone Number	:	513-886-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	7147 ENGLISH DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-3137
Country	:	US
Telephone Number	:	513-886-4044
Fax Number	:

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

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	05/17/2024

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