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General NPI Number Information
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NPI Number | 1033594775
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Entity Type | Individual
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Provider Name | NAYIVE ELLIS LSCSW
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Gender | Female
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 104 S. MAIN STREET
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City | JOHNSON
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State | KS
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Zip | 67855
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Country | US
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Telephone | 620-952-1738
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Fax | 620-492-3316
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Provider Business Mailing Address
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Address Line | 104 S. MAIN PO BOX 637
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City | JOHNSON
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State | KS
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Zip | 67855-0637
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Country | US
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Telephone | 620-952-1738
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Fax | 620-492-3316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9639
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4766
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License Number State | KS
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