Healthcare Provider Details

I. General information

NPI: 1023557295
Provider Name (Legal Business Name): POPPY EVANS LICENSED PROFESSIONAL COUNSELOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 N BEND RD
CINCINNATI OH
45239-7610
US

IV. Provider business mailing address

3253 N BEND RD
CINCINNATI OH
45239-7610
US

V. Phone/Fax

Practice location:
  • Phone: 513-662-9900
  • Fax: 513-662-9902
Mailing address:
  • Phone: 513-662-9900
  • Fax: 513-662-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0900042-S
License Number StateOH

VIII. Authorized Official

Name: POPPY EVANS
Title or Position: OWNER
Credential: LPCC
Phone: 513-662-9900