Provider Demographics
NPI:1467997544
Name:ELLIS, NATHANIEL DUKE (LPCC)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:DUKE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FORRER BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3137
Mailing Address - Country:US
Mailing Address - Phone:937-570-1063
Mailing Address - Fax:
Practice Address - Street 1:3045 RODENBECK DR STE 4
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2670
Practice Address - Country:US
Practice Address - Phone:513-376-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600656-TRNE101YP2500X, 101YM0800X
OHE.2001588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional