Provider Demographics
NPI:1043339021
Name:SEELY, ELLEN (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SEELY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 DOVER DR
Mailing Address - Street 2:SUITE 23
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5933
Mailing Address - Country:US
Mailing Address - Phone:949-650-2536
Mailing Address - Fax:949-650-3805
Practice Address - Street 1:833 DOVER DR
Practice Address - Street 2:SUITE 23
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5933
Practice Address - Country:US
Practice Address - Phone:949-650-2536
Practice Address - Fax:949-650-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist