Healthcare Provider Details

I. General information

NPI: 1902188212
Provider Name (Legal Business Name): TERRI ELLZEY M.S., M.A., MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 N 55TH ST
MILWAUKEE WI
53210-1558
US

IV. Provider business mailing address

2779 N 55TH ST
MILWAUKEE WI
53210-1558
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-3406
  • Fax: 414-344-0107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15749-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8032-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8032-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: