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General NPI Number Information
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NPI Number | 1326630203
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Entity Type | Organization
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Legal Business Name | STEPHANIE ELLIS, LICENSED CLINICAL SOCIAL WORKER, P.C.
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 30290 BUCCANEER BAY UNIT D
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City | MURRIETA
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State | CA
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Zip | 92563-8812
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Country | US
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Telephone | 951-246-6152
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Fax |
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Provider Business Mailing Address
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Address Line | 29910 MURRIETA HOT SPRINGS RD STE G304
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City | MURRIETA
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State | CA
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Zip | 92563-3814
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Country | US
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Telephone | 951-246-6152
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. DANA D ELLIS SR.
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Credential |
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Telephone | 951-246-6152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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