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General NPI Number Information
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NPI Number | 1346967122
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Entity Type | Organization
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Legal Business Name | MARCHANT HALSOR LLC ELLIE MENTAL HEALTH
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 2853 EXECUTIVE PARK DR
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City | WESTON
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State | FL
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Zip | 33331-3656
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Country | US
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Telephone | 954-800-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 NE 5TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-1325
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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
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Name | BENJAMIN MARCHANT
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Credential |
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Telephone | 206-618-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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