| Doctor Name: | KATRINA L ELLIS |
| NPI Number: | 1275952814 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC005689 |
| Business Practice Address: | 317 N Hudson St Altus, OK - 735213709 |
| Business Phone Number: | 5804822809 |
| Business Fax Number: | 5804822820 |
| Mailing Address: | 10 Kingsley Cir, ALTUS |
| State: | OK |
| Postal Code: | 735217451 |
| Phone Number: | 5804805970 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2014 |
| NPI Last Update Date: | 04/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC005689 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |