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General NPI Number Information
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NPI Number | 1154721728
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Entity Type | Individual
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Provider Name | ELIZABETH ANN ELLO CCAPP
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Gender | Female
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 11046 MAIN ST
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City | EL MONTE
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State | CA
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Zip | 91731-2617
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Country | US
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Telephone | 626-636-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 NASHPORT ST
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City | LA VERNE
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State | CA
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Zip | 91750-2433
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Country | US
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Telephone | 909-450-1938
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AII063251121
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License Number State | CA
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