Provider Demographics
NPI:1649430463
Name:ELLISON, ALYCE B (LPCC)
Entity type:Individual
Prefix:
First Name:ALYCE
Middle Name:B
Last Name:ELLISON
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 1:740 W GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-6002
Mailing Address - Country:US
Mailing Address - Phone:513-246-7337
Mailing Address - Fax:513-522-6147
Practice Address - Street 1:740 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-6002
Practice Address - Country:US
Practice Address - Phone:513-246-7337
Practice Address - Fax:513-522-6147
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHC.0800240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program