Provider Demographics
NPI:1699188789
Name:EID-NIENABER, PHYLLIS (LPCC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:EID-NIENABER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 MACK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5129
Mailing Address - Country:US
Mailing Address - Phone:513-860-1100
Mailing Address - Fax:
Practice Address - Street 1:5520 HARRISON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2362
Practice Address - Country:US
Practice Address - Phone:513-860-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional