Provider Demographics
NPI:1043476492
Name:GUMP, ELIZABETH EILEEN (LSW)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:EILEEN
Last Name:GUMP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1621
Mailing Address - Country:US
Mailing Address - Phone:216-904-7653
Mailing Address - Fax:
Practice Address - Street 1:429 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1621
Practice Address - Country:US
Practice Address - Phone:216-904-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0800363104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker