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General NPI Number Information
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NPI Number | 1316212913
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Entity Type | Individual
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Provider Name | JENNIFER M ELLIS LPC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 1816 W POINT PIKE STE 209
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City | LANSDALE
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State | PA
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Zip | 19446-5696
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Country | US
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Telephone | 609-413-6089
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Fax |
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Provider Business Mailing Address
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Address Line | 143 HEMLOCK DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2991
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Country | US
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Telephone | 609-413-6089
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PC006176
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License Number State | PA
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