| Doctor Name: | AMY CAROL ELLIS |
| NPI Number: | 1396850988 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.M.H.C. |
| License Number: | MH6475 |
| Business Practice Address: | 5200 Woodbine Rd Pace, FL - 325718715 |
| Business Phone Number: | 8502619032 |
| Business Fax Number: | 8509946958 |
| Mailing Address: | 5091 San Miguel St, MILTON |
| State: | FL |
| Postal Code: | 325835630 |
| Phone Number: | 8502619032 |
| Fax Number: | 8509946958 |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH6475 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |