Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 150556 | OH |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | 150556 | OH |
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 150556 | OH |
N | 101YP2500X | Professional Counselor | C.1500556 | OH |
N | 101YS0200X | School Counselor | 150556 | OH |
NPI | 1356891477 |
---|---|
Provider Name | Ellice Park |
First Address | Columbus, OH 43216 |
Second Address | Columbus, OH 43219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2016 |
Last Update Date | 03/09/2021 |