Healthcare Provider Details

I. General information

NPI: 1598067050
Provider Name (Legal Business Name): MEGHAN MARIE ELLIS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 S NORTH POINT RD
BALTIMORE MD
21224-3338
US

IV. Provider business mailing address

5433 E JOPPA RD
PERRY HALL MD
21128-9323
US

V. Phone/Fax

Practice location:
  • Phone: 443-216-4800
  • Fax:
Mailing address:
  • Phone: 480-236-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP3695
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: