Healthcare Provider Details

I. General information

NPI: 1457692808
Provider Name (Legal Business Name): ELIZABETH E BOBLITT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SOUTH EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

601 SOUTH EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 937-667-4963
Mailing address:
  • Phone: 937-734-8333
  • Fax: 937-667-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE1000089
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.100089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: