Healthcare Provider Details

I. General information

NPI: 1568658615
Provider Name (Legal Business Name): JOAN ELLISON PSYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N EL MOLINO AVE
PASADENA CA
91101-1403
US

IV. Provider business mailing address

355 AUBURN AVE
SIERRA MADRE CA
91024-1101
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-8480
  • Fax: 626-577-8978
Mailing address:
  • Phone: 914-536-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000388-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000256-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: