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General NPI Number Information
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NPI Number | 1952955361
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Entity Type | Individual
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Provider Name | VICTORIA P ELLIS
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Gender | Female
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 2700 WESTHALL LN STE 207
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City | MAITLAND
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State | FL
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Zip | 32751-7478
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Country | US
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Telephone | 813-464-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 11026 SAILBROOKE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-4036
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Country | US
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Telephone | 813-464-5353
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 15583
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License Number State | FL
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