# ELLICE PARK LLC DBA COUNSELING CARE CIRCLE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ellice Park LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457029373
- **Authorized official:** VIRTUAL MUSTARD SEED (AGENT)
- **Authorized official phone:** (614) 568-3233

## Contact information

- **Practice address:** 180 E BROAD ST, COLUMBUS, OH 43215-3707
- **Practice address phone:** (614) 568-3233
- **Mailing address:** PO BOX 2465, HARRISBURG, PA 17105-2465
- **Mailing address phone:** (614) 568-3233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YP1600X | Pastoral Counselor | — | NULL | — |
| 101YP1600X | Pastoral Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 101YS0200X | School Counselor | — | NULL | — |
| 101YS0200X | School Counselor | — | — | — |
| 102L00000X | Psychoanalyst | — | NULL | — |
| 102L00000X | Psychoanalyst | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 282J00000X | Religious Nonmedical Health Care Institution | — | NULL | — |
| 374K00000X | Religious Nonmedical Practitioner | — | NULL | — |
| 374K00000X | Religious Nonmedical Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/03/2021
- **Last updated:** 05/09/2026