MEDICARE: DR. ELLEN J HALVERSON M.D.

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	2084P0800X	Psychiatry Physician	4152	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467478164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN J HALVERSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 31001-4162
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4162
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 S WOODWORTH LOOP STE 202
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-7457
Country	:	US
Telephone Number	:	907-921-5050
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	02/25/2026

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