Healthcare Provider Details

I. General information

NPI: 1861987372
Provider Name (Legal Business Name): ELLEN L DAVIS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PINELAWN RD STE 204N
MELVILLE NY
11747-3133
US

IV. Provider business mailing address

159 COTTAGE LN
CHILLICOTHEE OH
45601-3716
US

V. Phone/Fax

Practice location:
  • Phone: 646-687-4646
  • Fax: 844-222-4005
Mailing address:
  • Phone: 740-703-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.2202896
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: