Healthcare Provider Details

I. General information

NPI: 1053507376
Provider Name (Legal Business Name): DANIELLE CHRISTINE ELLIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WEST LOOP S STE 575
BELLAIRE TX
77401-2913
US

IV. Provider business mailing address

541 FM 1488 RD APT 223
CONROE TX
77384-6003
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax:
Mailing address:
  • Phone: 713-594-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: