MEDICARE: KELLEE BETH ELLIS MED

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	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	E.1901095	OH

General Provider Information

NPI Number	:	1881749844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEE BETH ELLIS MED

Provider Business Mailing Address
First Line	:	248 MAIN ST APT 509
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-8168
Country	:	US
Telephone Number	:	602-513-9351
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 MAIN ST APT 509
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-8168
Country	:	US
Telephone Number	:	602-513-9351
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	03/17/2023

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Directions to “ KELLEE BETH ELLIS MED” Practice Location

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