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General NPI Number Information
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NPI Number | 1043688757
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Entity Type | Organization
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Legal Business Name | PATRICIA M ELLINGHAM
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 8800 49TH ST N STE 402
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City | PINELLAS PARK
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State | FL
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Zip | 33782-5353
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Country | US
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Telephone | 727-421-0595
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Fax | 727-712-0010
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Provider Business Mailing Address
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Address Line | 8800 49TH ST N STE 402
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City | PINELLAS PARK
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State | FL
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Zip | 33782-5353
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Country | US
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Telephone | 727-421-0595
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Fax | 727-712-0010
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PATRICIA M ELLINGHAM
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Credential | LMHC
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Telephone | 727-421-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC11163
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License Number State | FL
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