Provider Demographics
NPI:1417514944
Name:NOLAN, ELLISE
Entity Type:Individual
Prefix:
First Name:ELLISE
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 N HOLLAND SYLVANIA RD APT 2203
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3546
Mailing Address - Country:US
Mailing Address - Phone:502-216-3138
Mailing Address - Fax:
Practice Address - Street 1:3454 OAK ALLEY CT STE 400
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1355
Practice Address - Country:US
Practice Address - Phone:502-216-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901751-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health