Provider Demographics
NPI:1134104151
Name:POLANKA, ELIZABETH P (LPCC IMFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:P
Last Name:POLANKA
Suffix:
Gender:F
Credentials:LPCC IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N LOCUST ST
Mailing Address - Street 2:SUITE B 3
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1192
Mailing Address - Country:US
Mailing Address - Phone:513-523-8991
Mailing Address - Fax:513-523-8991
Practice Address - Street 1:10 N LOCUST ST
Practice Address - Street 2:SUITE B 3
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1192
Practice Address - Country:US
Practice Address - Phone:513-523-8991
Practice Address - Fax:513-523-8991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1045101YP2500X
OHE0007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH255395OtherANTHEM
OH429908685003OtherMEDICAL MUTUAL
6268092OtherUNITED BEHAVIOREL HEALTH