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NPI Code Detail

MEDICARE: TAMARA ELLIS

MEDICARE: TAMARA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1720931793
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA ELLIS
Provider Business Mailing Address
First Line : 1729 CATTAIL CREEK DR
Second Line :
City : DESOTO
State : TX
Zip : 75115-1720
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1801 ROYAL LN STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75229-3765
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2026
Last Update Date : 02/18/2026

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Directions to “ TAMARA 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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