Provider Demographics
NPI:1548697113
Name:FERRELL, MIA (LPCC)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:FERRELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:7251 SAMILL RD SUITE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MO
Mailing Address - Zip Code:43016
Mailing Address - Country:US
Mailing Address - Phone:614-766-0161
Mailing Address - Fax:614-766-0298
Practice Address - Street 1:1528 LONDON GROVEPORT RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8700
Practice Address - Country:US
Practice Address - Phone:614-766-0161
Practice Address - Fax:614-766-0298
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013035386101YM0800X
OHE1901409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013035386OtherLPC
OHE1901409OtherLPCC