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General NPI Number Information
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NPI Number | 1144023623
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Entity Type | Organization
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Legal Business Name | J. ELLISON AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1521 HIGHWAY 13 E
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City | BURNSVILLE
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State | MN
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Zip | 55337-2917
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Country | US
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Telephone | 612-964-8477
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Fax | 952-895-1946
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Provider Business Mailing Address
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Address Line | 1521 HIGHWAY 13 E
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City | BURNSVILLE
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State | MN
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Zip | 55337-2917
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Country | US
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Telephone | 612-964-8477
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Fax | 952-895-1946
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JESSICA DUPAY ELLISON
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Credential | LPCC
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Telephone | 612-964-8477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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