MEDICARE: MS. PAULA MARIA 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
1	101YP2500X	Professional Counselor		MO

General Provider Information

NPI Number	:	1346305927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA MARIA ELLIS LPC

Provider Business Mailing Address
First Line	:	5819 JULIAN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-2503
Country	:	US
Telephone Number	:	314-239-3618
Fax Number	:	314-389-0579

Provider Business Practice Location Address
First Line	:	5819 JULIAN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-2503
Country	:	US
Telephone Number	:	314-239-3618
Fax Number	:	314-389-0579

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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