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NPI Code Detail

MEDICARE: COURTNEY ELLIS MA, LMHC

MEDICARE: COURTNEY ELLIS MA, 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
1101YM0800XMental Health CounselorMH11235FL

General Provider Information

NPI Number : 1730515057
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY ELLIS MA, LMHC
Provider Business Mailing Address
First Line : 135 16TH AVE NE
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33704-4514
Country : US
Telephone Number : 727-742-5809
Fax Number :
Provider Business Practice Location Address
First Line : 275 4TH ST N
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33701-3205
Country : US
Telephone Number : 727-828-8364
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2013
Last Update Date : 09/18/2013

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Directions to “ COURTNEY ELLIS MA, LMHC” Practice Location

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