Provider Demographics
NPI:1245660752
Name:SIMPSON, ELLAREE LOUISE (LISW-S,LICOC, MSSA)
Entity type:Individual
Prefix:MS
First Name:ELLAREE
Middle Name:LOUISE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LISW-S,LICOC, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7654 SLATE RIDGE BLVD.
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068
Mailing Address - Country:US
Mailing Address - Phone:614-626-2696
Mailing Address - Fax:866-820-4098
Practice Address - Street 1:7654 SLATE RIDGE BLVD.
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068
Practice Address - Country:US
Practice Address - Phone:614-523-6629
Practice Address - Fax:866-820-4098
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH956835101YA0400X
OHI.1201237-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)