Healthcare Provider Details

I. General information

NPI: 1588491534
Provider Name (Legal Business Name): ELIZABETH MARIE GRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 CEDAR COVE DR
DAYTON OH
45459-6222
US

IV. Provider business mailing address

6800 CEDAR COVE DR
DAYTON OH
45459-6222
US

V. Phone/Fax

Practice location:
  • Phone: 513-720-6906
  • Fax:
Mailing address:
  • Phone: 513-720-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.2513235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: