Doctor Name: | MS. ELLEN LYNN SANTOLUCITO |
NPI Number: | 1003092404 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | 20069 |
Business Practice Address: | 1711 E Central Texas Expy Suite 108-6 Killeen, TX - 765419166 |
Business Phone Number: | 2542000083 |
Business Fax Number: | 2542000084 |
Mailing Address: | 1711 E Central Texas Expy, Suite 108-6 KILLEEN |
State: | TX |
Postal Code: | 765419166 |
Phone Number: | 2542000083 |
Fax Number: | 2542000084 |
NPI Enumeration Date: | 01/15/2008 |
NPI Last Update Date: | 01/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 20069 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |