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NPI Code Detail

MEDICARE: BRANDI SHAE ELLIS

MEDICARE: BRANDI SHAE ELLIS
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
1106H00000XMarriage & Family TherapistLMFT53223CA

General Provider Information

NPI Number : 1689997876
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI SHAE ELLIS
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 1855 2ND ST STE B
Second Line :
City : CONCORD
State : CA
Zip : 94519-2623
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2010
Last Update Date : 05/27/2022

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Directions to “ BRANDI SHAE ELLIS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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