Healthcare Provider Details

I. General information

NPI: 1083432777
Provider Name (Legal Business Name): ALYSON FAITH ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 SOCIALVILLE FOSTER RD STE 101
MASON OH
45040-7353
US

IV. Provider business mailing address

226 NAVAHO DR
LOVELAND OH
45140-2421
US

V. Phone/Fax

Practice location:
  • Phone: 513-322-5779
  • Fax:
Mailing address:
  • Phone: 513-254-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: