| Evan Ely, LPCC, LICDC | |
|
53 W Main St, Xenia, OH 45385-2979 | |
| (937) 971-2350 | |
| Not Available |
| Full Name | Evan Ely |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 53 W Main St, Xenia, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306398854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | E1100146 (Ohio) | Primary |
| Entity Name | Mahajan Therapeutics, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669531810 PECOS PAC ID: 8820236524 Enrollment ID: O20160809001647 |
| Mailing Address | Practice Location Address |
|---|---|
| Evan Ely, LPCC, LICDC Po Box 55, Walton, KY 41094-0055 Ph: () - | Evan Ely, LPCC, LICDC 53 W Main St, Xenia, OH 45385-2979 Ph: (937) 971-2350 |
Nikita Trimble, Counselor Medicare: Not Enrolled in Medicare Practice Location: 452 W Market St, Xenia, OH 45385 Phone: 937-376-8700 | |
Nikia Tamara Johnson, CDCA Counselor Medicare: Not Enrolled in Medicare Practice Location: 996 N Monroe Ct, Xenia, OH 45385 Phone: 937-708-8348 | |
Robert A Leveck, Counselor Medicare: Not Enrolled in Medicare Practice Location: 452 W Market St, Xenia, OH 45385 Phone: 937-532-9306 | |
Mr. Frank Bush, Counselor Medicare: Not Enrolled in Medicare Practice Location: 137 N Allison Ave, Xenia, OH 45385 Phone: 937-708-8000 | |
Alan Jefferis, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 452 W Market St, Xenia, OH 45385 Phone: 937-376-8700 Fax: 937-376-8725 | |
Richard Young, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 452 W Market St, Xenia, OH 45385 Phone: 937-376-8700 Fax: 937-376-0184 | |
Jillian Vincent, Counselor Medicare: Not Enrolled in Medicare Practice Location: 452 W Market St, Xenia, OH 45385 Phone: 937-376-8700 Fax: 937-376-8725 |