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General NPI Number Information
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NPI Number | 1770333627
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Entity Type | Organization
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Legal Business Name | ELLISON DAVIS COUNSELING AND WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1127 AUBURN VIEW LN
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City | FRESNO
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State | TX
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Zip | 77545-2049
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Country | US
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Telephone | 281-740-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 HIGHWAY 6 # 1318
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3802
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Country | US
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Telephone | 281-740-7245
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | SHANTE F CLARK-DAVIS
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Credential | LPC
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Telephone | 281-740-7245
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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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