Healthcare Provider Details

I. General information

NPI: 1134438153
Provider Name (Legal Business Name): JOSEPH MICHAEL ELY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 PAXTON AVE
PALMDALE CA
93551-1015
US

IV. Provider business mailing address

1860 QUAIL RUN WAY
SPRING HILL TN
37174-4203
US

V. Phone/Fax

Practice location:
  • Phone: 661-524-9940
  • Fax: 661-524-9950
Mailing address:
  • Phone: 661-361-9444
  • Fax: 661-579-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW75256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: