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General NPI Number Information
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NPI Number | 1144705369
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Entity Type | Individual
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Provider Name | MONICA U. ELLIS-BLIED PHD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 105 SPRING ST
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City | CLAREMONT
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State | CA
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Zip | 91711-4930
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Country | US
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Telephone | 909-741-2849
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Fax | 909-992-4101
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Provider Business Mailing Address
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Address Line | 105 SPRING ST
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City | CLAREMONT
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State | CA
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Zip | 91711-4930
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Country | US
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Telephone | 323-351-9793
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Fax |
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PSY30328
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY30328
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License Number State | CA
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