Healthcare Provider Details

I. General information

NPI: 1437486180
Provider Name (Legal Business Name): NATIONAL EDUCATIONAL TRAINING SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 AUTUMN TRL
RINGGOLD GA
30736-4191
US

IV. Provider business mailing address

376 AUTUMN TRL
RINGGOLD GA
30736-4191
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-8522
  • Fax: 866-799-3496
Mailing address:
  • Phone: 727-365-8522
  • Fax: 866-799-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY3273
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberPSY3273
License Number StateGA

VIII. Authorized Official

Name: DR. LESLIE ELAINE ELLLIS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 727-365-8522