Provider Demographics
NPI:1033975842
Name:FITZSIMMONS-CRAFT, ELLEN E (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:E
Last Name:FITZSIMMONS-CRAFT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:E
Other - Last Name:FITZSIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:3960 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3918
Mailing Address - Country:US
Mailing Address - Phone:314-341-3238
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-286-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015042595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical