Provider Demographics
NPI:1689411324
Name:ANSARI, NAFEESAH
Entity type:Individual
Prefix:
First Name:NAFEESAH
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8977 COLUMBIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1100
Mailing Address - Country:US
Mailing Address - Phone:513-409-3635
Mailing Address - Fax:513-402-0408
Practice Address - Street 1:8977 COLUMBIA RD STE A
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1100
Practice Address - Country:US
Practice Address - Phone:513-409-3635
Practice Address - Fax:513-402-0408
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.138775.MEDS-IV164W00000X
101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)