Healthcare Provider Details

I. General information

NPI: 1417873878
Provider Name (Legal Business Name): JEN ELLIS LMHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 MAIN ST
BOYLSTON MA
01505-1449
US

IV. Provider business mailing address

727 MAIN ST
BOYLSTON MA
01505-1449
US

V. Phone/Fax

Practice location:
  • Phone: 978-612-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER ELLIS
Title or Position: PRIVATE PRACTICE OWNER
Credential:
Phone: 978-612-6611