Provider Demographics
NPI:1871706150
Name:DASH, ELLEN W (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:W
Last Name:DASH
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 1:1206 HIGHWAY 411
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2455
Mailing Address - Country:US
Mailing Address - Phone:423-884-7271
Mailing Address - Fax:423-884-3277
Practice Address - Street 1:1206 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2455
Practice Address - Country:US
Practice Address - Phone:423-884-7271
Practice Address - Fax:423-884-3277
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000145101YP2500X
TN0145101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4020816OtherBLUE CROSS AND BLUE SHIEL
TN1509981Medicaid