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General NPI Number Information
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NPI Number | 1407265663
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Entity Type | Organization
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Legal Business Name | ELLIS THERAPY ASSOCIATES
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 2001 HUDSON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-1889
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Country | US
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Telephone | 269-341-9725
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 HUDSON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-1889
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Country | US
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Telephone | 269-341-9725
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. CATHERINE E ELLIS
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Credential | MA,LLP
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Telephone | 269-341-9725
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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 | 6401004435
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301007514
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License Number State | MI
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