MEDICARE: JEANETTE CHRISTINE ELLIS LPC

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	:	1982310801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE CHRISTINE ELLIS LPC

Provider Business Mailing Address
First Line	:	311 N HAMMONDS FERRY RD
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-1914
Country	:	US
Telephone Number	:	410-684-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N HAMMONDS FERRY RD
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-1914
Country	:	US
Telephone Number	:	410-684-9893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	01/24/2023

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