MEDICARE: ALYCE B ELLISON LPCC

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YP2500X	Professional Counselor	C.0800240	OH

General Provider Information

NPI Number	:	1649430463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYCE B ELLISON LPCC

Provider Business Mailing Address
First Line	:	740 W GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-6002
Country	:	US
Telephone Number	:	513-246-7337
Fax Number	:	513-522-6147

Provider Business Practice Location Address
First Line	:	740 W GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-6002
Country	:	US
Telephone Number	:	513-246-7337
Fax Number	:	513-522-6147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	11/16/2023

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