Provider Demographics
NPI:1982596086
Name:BRABANT, ELLEN MARIS (LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIS
Last Name:BRABANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30600 MANHASSET DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1157
Mailing Address - Country:US
Mailing Address - Phone:440-429-1179
Mailing Address - Fax:
Practice Address - Street 1:38100 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1031
Practice Address - Country:US
Practice Address - Phone:440-961-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2506730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor