=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104334770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINCINNATI COUNSELING AND PLAY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2018
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4424 CARVER WOODS DR STE 100
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-5535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-449-0799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4424 CARVER WOODS DR STE 100
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-5535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-449-0799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER LIU
-----------------------------------------------------
Credential | LPCC-S
-----------------------------------------------------
Telephone | 513-374-8095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E1200233-SUPV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------