Healthcare Provider Details

I. General information

NPI: 1548776610
Provider Name (Legal Business Name): JASMINE D ELLISTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JASMINE BREFELD

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 DANA AVE STE 220
CINCINNATI OH
45207-1342
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608653
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: