Healthcare Provider Details

I. General information

NPI: 1194332809
Provider Name (Legal Business Name): KAREN LORI ELLARD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2020
Last Update Date: 09/26/2020
Certification Date: 09/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 HAGLER COALING RD
COTTONDALE AL
35453-2726
US

IV. Provider business mailing address

PO BOX 750
COALING AL
35449-0750
US

V. Phone/Fax

Practice location:
  • Phone: 205-292-1658
  • Fax:
Mailing address:
  • Phone: 205-292-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1149C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: