Provider Demographics
NPI:1912330382
Name:ELLISON, LEON (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W HIGHWAY 80 STE A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2700
Mailing Address - Country:US
Mailing Address - Phone:513-550-8506
Mailing Address - Fax:
Practice Address - Street 1:81 W HIGHWAY 80 STE A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2700
Practice Address - Country:US
Practice Address - Phone:606-416-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252814101YM0800X
OHE1600105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health