| Doctor Name: | MARY ANN ELLIS |
| NPI Number: | 1295042869 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.S. |
| License Number: | SS 830 |
| Business Practice Address: | 20114 E Pennsylvania Ave Dunnellon, FL - 344326033 |
| Business Phone Number: | 3524652444 |
| Business Fax Number: | 3524657854 |
| Mailing Address: | 20114 E Pennsylvania Ave, DUNNELLON |
| State: | FL |
| Postal Code: | 344326033 |
| Phone Number: | 3524652444 |
| Fax Number: | 3524657854 |
| NPI Enumeration Date: | 09/02/2010 |
| NPI Last Update Date: | 09/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | SS 830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |