=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962306597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLIS MENTAL HEALTH CO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2026
-----------------------------------------------------
Last Update Date | 10/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13470 S ARAPAHO DR STE 180
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062-1656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-421-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10420 S RIDGEVIEW RD # 1033
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-421-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALIYAH ELLIS
-----------------------------------------------------
Credential | APRN, PMHNP-BC
-----------------------------------------------------
Telephone | 913-421-3366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------