Healthcare Provider Details

I. General information

NPI: 1669093035
Provider Name (Legal Business Name): ELAI FREED LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E WOOSTER ST STE A
BOWLING GREEN OH
43402-9083
US

IV. Provider business mailing address

885 COMMERCE DR
PERRYSBURG OH
43551-5267
US

V. Phone/Fax

Practice location:
  • Phone: 419-379-1813
  • Fax:
Mailing address:
  • Phone: 419-330-1050
  • Fax: 419-931-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203172
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: