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NPI Code Detail

MEDICARE: GENEVIEVE BRIENNE ELLIS LPC

MEDICARE: GENEVIEVE BRIENNE ELLIS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC014369GA

General Provider Information

NPI Number : 1104537380
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVIEVE BRIENNE ELLIS LPC
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 STONEFOREST DR STE 230
Second Line :
City : WOODSTOCK
State : GA
Zip : 30189-4903
Country : US
Telephone Number : 470-552-8470
Fax Number : 470-437-3924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2022
Last Update Date : 01/08/2026

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Directions to “ GENEVIEVE BRIENNE ELLIS LPC” Practice Location

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