Provider Demographics
NPI:1053460246
Name:ADKINS, ELLEN KUBAY (LISW IMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:KUBAY
Last Name:ADKINS
Suffix:
Gender:F
Credentials:LISW IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 ORTON RD
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1321
Mailing Address - Country:US
Mailing Address - Phone:937-433-4430
Mailing Address - Fax:
Practice Address - Street 1:77 W ELMWOOD DR
Practice Address - Street 2:SUITE 116
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-4239
Practice Address - Country:US
Practice Address - Phone:937-433-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI3751041C0700X
OHF 0000132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist