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General NPI Number Information
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NPI Number | 1235579475
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Entity Type | Organization
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Legal Business Name | ELLIS THERAPY & CONSULTING, LLC
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 7229 WOODSTEAD CT APT 5
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City | SAINT LOUIS
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State | MO
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Zip | 63121-2306
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Country | US
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Telephone | 314-459-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 7229 WOODSTEAD CT APT 5
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City | SAINT LOUIS
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State | MO
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Zip | 63121-2306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | CANDACE ANTHONY
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Credential |
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Telephone | 314-459-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2011013937
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License Number State | MO
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