| NPI | 1457029373 |
|---|---|
| Other Name | ELLICE PARK LLC |
| Entity Type | Organization |
| Authorized Contact | VIRTUAL MUSTARD SEED Agent 614-568-3233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| 101YS0200X Counselor, School | |
| 102L00000X Psychoanalyst | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106S00000X Behavior Technician | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 282J00000X Religious Nonmedical Health Care Institution | |
| 374K00000X | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2025-02-03 |