Provider Demographics
NPI:1124546866
Name:SPRAGUE, ELIJAH (LICDC, LPCC-S)
Entity type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:LICDC, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1518
Mailing Address - Country:US
Mailing Address - Phone:937-661-1387
Mailing Address - Fax:
Practice Address - Street 1:233 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1518
Practice Address - Country:US
Practice Address - Phone:937-661-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161479101YA0400X
OHE.2102241101YP2500X
OHLE-00042117101YM0800X
OHC.1500918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional