| Doctor Name: | KIMBERLY R ELLIS |
| NPI Number: | 1104066299 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAC |
| License Number: | A0909102 |
| Business Practice Address: | 201 S Rose St Sheridan, AR - 721502451 |
| Business Phone Number: | 8709172171 |
| Business Fax Number: | 8709172161 |
| Mailing Address: | 201 S Rose St, SHERIDAN |
| State: | AR |
| Postal Code: | 721502451 |
| Phone Number: | 8709172171 |
| Fax Number: | 8709172161 |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 12/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | A0909102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |