Provider Demographics
NPI:1043361678
Name:ELLIS, ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:270 SPARTA AVE
Mailing Address - Street 2:#203
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1122
Mailing Address - Country:US
Mailing Address - Phone:973-573-1500
Mailing Address - Fax:
Practice Address - Street 1:270 SPARTA AVE
Practice Address - Street 2:#203
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1122
Practice Address - Country:US
Practice Address - Phone:973-573-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00296500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional