| Doctor Name: | ALICE A ELLIS |
| NPI Number: | 1053682674 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | LPCPCC00216428 |
| Business Practice Address: | 3651 Shepherdsville Rd Elizabethtown, KY - 427019511 |
| Business Phone Number: | 2704015450 |
| Business Fax Number: | 2704015450 |
| Mailing Address: | 3651 Shepherdsville Rd, ELIZABETHTOWN |
| State: | KY |
| Postal Code: | 427019511 |
| Phone Number: | 2704015450 |
| Fax Number: | 2704015450 |
| NPI Enumeration Date: | 01/13/2012 |
| NPI Last Update Date: | 08/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPCPCC00216428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |