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General NPI Number Information
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NPI Number | 1487372132
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Entity Type | Organization
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Legal Business Name | BELLAIRE ELLIE CLINIC PC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 6300 WEST LOOP S STE 110
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City | BELLAIRE
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State | TX
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Zip | 77401-2919
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Country | US
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Telephone | 832-924-0348
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Fax | 832-852-5754
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Provider Business Mailing Address
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Address Line | 6300 WEST LOOP S STE 110
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City | BELLAIRE
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State | TX
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Zip | 77401-2919
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Country | US
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Telephone | 832-924-0348
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Fax | 832-852-5754
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Authorized Official
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Title or Position | OWNER
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Name | JENIFFER K ESCLOVON
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Credential | LPC-S
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Telephone | 409-626-1329
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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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