Provider Demographics
NPI:1871855577
Name:ELIZABETH A BLOSSER, LLC
Entity Type:Organization
Organization Name:ELIZABETH A BLOSSER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:PCC
Authorized Official - Phone:614-230-7374
Mailing Address - Street 1:6797 N HIGH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2533
Mailing Address - Country:US
Mailing Address - Phone:614-505-7455
Mailing Address - Fax:
Practice Address - Street 1:6797 N HIGH ST STE 212
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-505-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-09
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty