Healthcare Provider Details

I. General information

NPI: 1700439338
Provider Name (Legal Business Name): ELIZABETH JILL CROSWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 HOSBROOK RD STE 300
CINCINNATI OH
45236-2932
US

IV. Provider business mailing address

1775 E MCMILLAN ST APT 1
CINCINNATI OH
45206-2171
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5990
  • Fax: 513-792-3308
Mailing address:
  • Phone: 513-722-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1100437
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1100437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: