Doctor Name: | JENNIFER M ELLIS |
NPI Number: | 1316212913 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC006176 |
Business Practice Address: | 105 Chesley Dr Unit 5 Media, PA - 190631754 |
Business Phone Number: | 6094136089 |
Business Fax Number: | |
Mailing Address: | 464 Parker Ave, PHILADELPHIA |
State: | PA |
Postal Code: | 191284402 |
Phone Number: | 6094136089 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2012 |
NPI Last Update Date: | 12/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | PC006176 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
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 |