Provider Demographics
NPI:1942754940
Name:KNISLEY, ELISABETH A (LPC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:KNISLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8409
Mailing Address - Country:US
Mailing Address - Phone:740-446-5500
Mailing Address - Fax:740-446-4951
Practice Address - Street 1:112 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-2192
Practice Address - Fax:740-992-4018
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200820Medicaid