Healthcare Provider Details

I. General information

NPI: 1942919790
Provider Name (Legal Business Name): ROSALIND ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST
COLUMBUS MS
39701-4751
US

IV. Provider business mailing address

131 HOTEL ST
CRAWFORD MS
39743
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-9225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-0924
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: