Healthcare Provider Details

I. General information

NPI: 1639857121
Provider Name (Legal Business Name): EMILY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11438 LEBANON RD UNIT H
CINCINNATI OH
45241-6201
US

IV. Provider business mailing address

11438 LEBANON RD UNIT H
CINCINNATI OH
45241-6201
US

V. Phone/Fax

Practice location:
  • Phone: 513-485-2033
  • Fax:
Mailing address:
  • Phone: 513-485-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: