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General NPI Number Information
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NPI Number | 1679941751
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Entity Type | Organization
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Legal Business Name | ELLIS PROFESSIONAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 3651 SHEPHERDSVILLE RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9511
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Country | US
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Telephone | 270-401-5450
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Fax | 270-360-0767
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Provider Business Mailing Address
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Address Line | 3651 SHEPHERDSVILLE RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9511
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Country | US
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Telephone | 270-401-5450
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Fax | 270-360-0767
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MS. ALICE A ELLIS
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Credential | LPCC
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Telephone | 270-401-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCPCC00216428
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License Number State | KY
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