MEDICARE: MRS. PATRICIA MARIE ELLINGHAM LMHC

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	LMHC-11163	FL
2	101YM0800X	Mental Health Counselor	11163	FL

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	:	1710255245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA MARIE ELLINGHAM LMHC

Provider Business Mailing Address
First Line	:	9365 US HIGHWAY 19 N STE B
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-5400
Country	:	US
Telephone Number	:	727-421-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	9365 US HIGHWAY 19 N
Second Line	:	ST B
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-5400
Country	:	US
Telephone Number	:	727-421-0595
Fax Number	:

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

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/09/2025

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