MEDICARE: ROBERT CHRISTOPHER ELLIS LPCC

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
1	101YM0800X	Mental Health Counselor	CMH0222381	NM
2	101YP2500X	Professional Counselor	CTB20230533	NM

General Provider Information

NPI Number	:	1144709379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHRISTOPHER ELLIS LPCC

Provider Business Mailing Address
First Line	:	530 N CHURCH ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3440
Country	:	US
Telephone Number	:	575-526-9878
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 N CHURCH ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3440
Country	:	US
Telephone Number	:	575-526-9878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	10/10/2023

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