MEDICARE: ELLIS GROUP COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1124509971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS GROUP COUNSELING

Provider Business Mailing Address
First Line	:	2118 BIRDCREEK DR STE 100
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-1020
Country	:	US
Telephone Number	:	254-300-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 BIRDCREEK DR STE 100
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-1020
Country	:	US
Telephone Number	:	254-300-6313
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MS. EMILY K ELLIS
Credential	:	LPC
Telephone Number	:	254-300-6313

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	12/04/2025

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