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General NPI Number Information
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NPI Number | 1245660752
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Entity Type | Individual
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Provider Name | ELLAREE LOUISE SIMPSON LISW-S,LICOC, MSSA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 7654 SLATE RIDGE BLVD.
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City | REYNOLDSBURG
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State | OH
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Zip | 43068
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Country | US
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Telephone | 614-523-6629
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Fax | 866-820-4098
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Provider Business Mailing Address
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Address Line | 7654 SLATE RIDGE BLVD.
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City | REYNOLDSBURG
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State | OH
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Zip | 43068
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Country | US
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Telephone | 614-626-2696
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Fax | 866-820-4098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 956835
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1201237-SUPV
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License Number State | OH
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