Provider Demographics
NPI:1053682674
Name:ELLIS, ALICE A (LPCC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:L
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3651 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9511
Mailing Address - Country:US
Mailing Address - Phone:270-401-5450
Mailing Address - Fax:270-401-5450
Practice Address - Street 1:3651 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9511
Practice Address - Country:US
Practice Address - Phone:270-401-5450
Practice Address - Fax:270-401-5450
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00216428101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional