Organization Name: | MARY ANN ELLIS |
NPI Number: | 1639229362 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY ANN ELLIS (SCHOOL PSYCHOLOGIST) |
Mailing Address: | 20114 East Pennsylvania Avenue Dunnellon |
State: | FL US |
Postal Code: | 34432 |
Phone Number: | 3524652444 |
Fax Number: | 3524657854 |
NPI Enumeration Date: | 01/12/2007 |
NPI Last Update Date: | 07/23/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | SS830 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |