Healthcare Provider Details

I. General information

NPI: 1568176642
Provider Name (Legal Business Name): ELIZABETH MCCOLLISTER CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLIE MCCOLLISTER CT

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CHARRING CROSS DR S
WESTERVILLE OH
43081-2862
US

IV. Provider business mailing address

4040 SAVILLE CT
COLUMBUS OH
43224-1773
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-8262
  • Fax:
Mailing address:
  • Phone: 513-252-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2204448-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: