Etta Louise Charlebois, LISW-S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

I-0005459 Issued in OH

Practice address

434 Home Street
Georgetown, OH 45121-9321

Phone

(937) 378-2979

Fax

(937) 378-2970

NPI assigned

Dec 4, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1831371640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15618 HILLCREST RD",
            "city": "MOUNT ORAB",
            "state": "OH",
            "postal_code": "451548507",
            "telephone_number": "513-460-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 HOME STREET",
            "city": "GEORGETOWN",
            "state": "OH",
            "postal_code": "451219321",
            "telephone_number": "937-378-2979",
            "fax_number": "937-378-2970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15618 Hillcrest Rd",
            "address_purpose": "LOCATION",
            "city": "Mount Orab",
            "state": "OH",
            "postal_code": "451548507",
            "country_code": "US",
            "telephone_number": "937-712-2438",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHARLEBOIS",
        "first_name": "ETTA",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "I-0005459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Georgetown, OH
• Providers in Georgetown, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.