Provider Demographics
NPI:1730714460
Name:ELLSWORTH, JODIE R (LPCC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:R
Last Name:ELLSWORTH
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 1:203 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3132
Mailing Address - Country:US
Mailing Address - Phone:270-826-8761
Mailing Address - Fax:270-826-8737
Practice Address - Street 1:1055 NATIONAL MINE DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8913
Practice Address - Country:US
Practice Address - Phone:270-821-8884
Practice Address - Fax:270-821-8885
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional