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NPI Code Detail

MEDICARE: TERESA ELLIS

MEDICARE: TERESA ELLIS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorOH

General Provider Information

NPI Number : 1568075927
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA ELLIS
Provider Business Mailing Address
First Line : 1825 S 2ND ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-2457
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8308 OHIO RIVER RD STE B
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-1713
Country : US
Telephone Number : 740-529-1201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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Directions to “ TERESA ELLIS ” Practice Location

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