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NPI Code Detail

MEDICARE: MR. JOHN M. ELLIS LISW, LICDC

MEDICARE: MR. JOHN M. ELLIS LISW, LICDC
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
11041C0700XClinical Social WorkerI-0009904OH
2101YA0400XAddiction (Substance Use Disorder) Counselor923272OH

General Provider Information

NPI Number : 1326063363
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN M. ELLIS LISW, LICDC
Provider Business Mailing Address
First Line : 35888 CENTER RIDGE RD
Second Line : SUITE 5
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-3086
Country : US
Telephone Number : 440-327-1800
Fax Number : 440-327-1533
Provider Business Practice Location Address
First Line : 35888 CENTER RIDGE RD
Second Line : SUITE 5
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-3086
Country : US
Telephone Number : 440-327-1800
Fax Number : 440-327-1533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 09/11/2025

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