Healthcare Provider Details

I. General information

NPI: 1194644542
Provider Name (Legal Business Name): MS. PATRICIA STRONG ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N PROSPECT AVE STE L6
REDONDO BEACH CA
90277-3037
US

IV. Provider business mailing address

605 GOULD TER
HERMOSA BEACH CA
90254-2240
US

V. Phone/Fax

Practice location:
  • Phone: 424-634-1956
  • Fax:
Mailing address:
  • Phone: 310-753-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: