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General NPI Number Information
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NPI Number | 1154609998
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Entity Type | Individual
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Provider Name | NATHAN CODY ELLIS LCPC
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Gender | Male
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 703 S AMERICANA BLVD STE 150
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City | BOISE
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State | ID
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Zip | 83702-4976
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Country | US
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Telephone | 208-706-6375
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Fax | 208-706-6395
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | NAMPA
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State | ID
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Zip | 83653-0009
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Country | US
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Telephone | 208-461-7149
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Fax | 208-467-3391
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4858
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4858
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4858
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-7528
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4858
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License Number State | ID
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Taxonomy #6
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 4858
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License Number State | ID
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-7528
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License Number State | ID
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