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General NPI Number Information
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NPI Number | 1679232136
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Entity Type | Individual
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Provider Name | ANNA ELLIS MA, LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1875 STATION PKWY NW
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City | ANDOVER
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State | MN
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Zip | 55304-3319
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Country | US
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Telephone | 763-482-9598
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Fax |
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Provider Business Mailing Address
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Address Line | 18205 45TH AVE N STE D
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City | PLYMOUTH
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State | MN
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Zip | 55446-4594
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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 |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 305435
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3115
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License Number State | MN
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