Provider Demographics
NPI:1861685505
Name:ELLEGOOD, LORI A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:ELLEGOOD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:TURNBOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:724 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6813
Mailing Address - Country:US
Mailing Address - Phone:812-447-2464
Mailing Address - Fax:
Practice Address - Street 1:724 3RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6813
Practice Address - Country:US
Practice Address - Phone:812-447-2464
Practice Address - Fax:800-447-9171
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005397A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical