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NPI Code Detail

MEDICARE: EBONY STUTSON LPC

MEDICARE: EBONY STUTSON LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorC.2002549OH
2101YM0800XMental Health CounselorC.2002549OH

General Provider Information

NPI Number : 1114237989
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY STUTSON LPC
Provider Business Mailing Address
First Line : 11156 CANAL RD STE A
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5816
Country : US
Telephone Number : 513-772-6166
Fax Number : 513-772-6177
Provider Business Practice Location Address
First Line : 11156 CANAL RD STE A
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5816
Country : US
Telephone Number : 513-772-6166
Fax Number : 513-772-6177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2010
Last Update Date : 08/02/2022

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