Organization Name: | PATRICIA M ELLINGHAM |
NPI Number: | 1043688757 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATRICIA M ELLINGHAM (OWNER) |
Mailing Address: | 8800 49th St N Ste 402 Pinellas Park |
State: | FL US |
Postal Code: | 337825353 |
Phone Number: | 7274210595 |
Fax Number: | 7277120010 |
NPI Enumeration Date: | 09/11/2015 |
NPI Last Update Date: | 09/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LMHC11163 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |