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General NPI Number Information
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NPI Number | 1134018492
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Entity Type | Organization
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Legal Business Name | ELLIS PSYCHIATRIC HEALTHCARE LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 7050 S HIGHLAND DR STE 210
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3762
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Country | US
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Telephone | 801-878-4081
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Fax | 801-432-8264
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Provider Business Mailing Address
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Address Line | 7050 S HIGHLAND DR STE 210
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3762
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Country | US
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Telephone | 801-878-4081
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Fax | 801-432-8264
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAM ELLIS
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Credential |
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Telephone | 801-664-7803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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