Healthcare Provider Details

I. General information

NPI: 1912045238
Provider Name (Legal Business Name): ELIZABETH E EMMERT LSW LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

IV. Provider business mailing address

102 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-5416
  • Fax: 740-392-3742
Mailing address:
  • Phone: 740-392-5416
  • Fax: 740-392-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0001842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: