Healthcare Provider Details

I. General information

NPI: 1497183131
Provider Name (Legal Business Name): ELLINGTON COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HERMOSA DR
ROSWELL NM
88201-6541
US

IV. Provider business mailing address

PO BOX 4427
ROSWELL NM
88202-4427
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-2426
  • Fax:
Mailing address:
  • Phone: 575-622-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1501
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1501
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1501
License Number StateNM

VIII. Authorized Official

Name: MR. RONALD E. ELLINGTON
Title or Position: OWNER
Credential: LPCC
Phone: 575-622-2426