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General NPI Number Information
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NPI Number | 1609297282
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Entity Type | Individual
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Provider Name | ELAINE MALLON GRUBB PCC
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Gender | Female
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 161 S LIBERTY ST
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City | POWELL
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State | OH
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Zip | 43065-7619
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Country | US
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Telephone | 614-789-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 4837 INISHEER CT
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City | DUBLIN
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State | OH
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Zip | 43017-9170
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Country | US
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Telephone | 614-395-2055
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Fax | 614-789-0300
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0800450
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License Number State | OH
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