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General NPI Number Information
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NPI Number | 1174278642
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Entity Type | Individual
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Provider Name | SARAH MARIE ELLIS LPC-C
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Gender | Female
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2617 GENERAL PERSHING BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73107-6437
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Country | US
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Telephone | 405-858-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E 15TH ST STE 800B
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City | EDMOND
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State | OK
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Zip | 73013-6682
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Country | US
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Telephone | 405-455-6868
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-203468
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License Number State | OK
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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 | LPCCANDIDATE11852
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License Number State | OK
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