Healthcare Provider Details

I. General information

NPI: 1528116985
Provider Name (Legal Business Name): ELLIS MORGAN CRAIG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BISHOP ST
SAN MARCOS TX
78666-2706
US

IV. Provider business mailing address

819 WATER ST SUITE 300
KERRVILLE TX
78028-5333
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-7104
  • Fax:
Mailing address:
  • Phone: 830-792-3300
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number21390
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: