MEDICARE: PAIGE BALLENGEE LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700649878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE BALLENGEE LLC

Provider Business Mailing Address
First Line	:	4855 EASTERN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-4450
Country	:	US
Telephone Number	:	513-655-6823
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 EASTERN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-4450
Country	:	US
Telephone Number	:	513-655-6823
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALLYSON P BALLENGEE
Credential	:	LPCC-S LICIC
Telephone Number	:	614-946-8912

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “PAIGE BALLENGEE LLC ” Practice Location

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