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General NPI Number Information
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NPI Number | 1275660730
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Entity Type | Individual
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Provider Name | JOANNA ELLIS MA
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1355 WESTWOOD BLVD STE 206
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City | LOS ANGELES
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State | CA
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Zip | 90024-4944
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Country | US
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Telephone | 310-266-0860
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 N CURSON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-2805
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Country | US
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Telephone | 310-266-0860
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Fax | 323-845-0197
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC36380
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License Number State | CA
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