Healthcare Provider Details

I. General information

NPI: 1891937843
Provider Name (Legal Business Name): DAVID ELLNER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD LOS ANGELES
LOS ANGELES CA
90045-3631
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD LOS ANGELES
LOS ANGELES CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7417
  • Fax: 310-337-7413
Mailing address:
  • Phone: 310-337-7417
  • Fax: 310-337-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29769
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: