Healthcare Provider Details

I. General information

NPI: 1295489987
Provider Name (Legal Business Name): DAWN M ELLIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 S 51ST CT STE G
FORT SMITH AR
72903-3666
US

IV. Provider business mailing address

2408 S 51ST CT STE G
FORT SMITH AR
72903-3666
US

V. Phone/Fax

Practice location:
  • Phone: 479-323-2424
  • Fax:
Mailing address:
  • Phone: 479-323-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2405003
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: