Healthcare Provider Details

I. General information

NPI: 1730052614
Provider Name (Legal Business Name): ELLERY WREN LPC ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 S STATE ST # 2
BELLINGHAM WA
98225-5826
US

IV. Provider business mailing address

337 S STATE ST # 2
BELLINGHAM WA
98225-5826
US

V. Phone/Fax

Practice location:
  • Phone: 214-997-0944
  • Fax:
Mailing address:
  • Phone: 214-997-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: