Healthcare Provider Details

I. General information

NPI: 1083125371
Provider Name (Legal Business Name): MICHELLE KHAN LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11804 CONREY RD STE 100
CINCINNATI OH
45249-1076
US

IV. Provider business mailing address

11804 CONREY RD
CINCINNATI OH
45249-1072
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1000
  • Fax: 513-985-2182
Mailing address:
  • Phone: 513-984-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1800826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: