Healthcare Provider Details

I. General information

NPI: 1992262653
Provider Name (Legal Business Name): CHRISTINE ELLIS LPC LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 ARBOR SPRINGS DR
HAMILTON OH
45013-1865
US

IV. Provider business mailing address

1141 ARBOR SPRINGS DR
HAMILTON OH
45013-1865
US

V. Phone/Fax

Practice location:
  • Phone: 513-919-6338
  • Fax:
Mailing address:
  • Phone: 513-919-6338
  • Fax: 513-919-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberC.2002664-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162252
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168065
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2103639
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: