MEDICARE: ELLEN GORMLEY 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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E2102611	OTHER	OH	OHCSMFT BOARD

General Provider Information

NPI Number	:	1841944501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN GORMLEY LPCC

Provider Business Mailing Address
First Line	:	1691 CLIFF RD
Second Line	:
City	:	NORTH BEND
State	:	OH
Zip	:	45052-9636
Country	:	US
Telephone Number	:	513-505-2981
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 DANA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1313
Country	:	US
Telephone Number	:	513-505-2981
Fax Number	:

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

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “ ELLEN GORMLEY LPCC” Practice Location

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