Provider Demographics
NPI:1003353772
Name:ELLIS, JOEY WAYNE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:WAYNE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-6838
Mailing Address - Country:US
Mailing Address - Phone:254-415-5270
Mailing Address - Fax:
Practice Address - Street 1:2688 SNOW RD
Practice Address - Street 2:
Practice Address - City:KEMPNER
Practice Address - State:TX
Practice Address - Zip Code:76539-6838
Practice Address - Country:US
Practice Address - Phone:254-415-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health