Provider Demographics
NPI:1093481756
Name:ELLIS, KATE (CLINICAL COUNSELING)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CLINICAL COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 E 5TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3837
Mailing Address - Country:US
Mailing Address - Phone:480-695-1936
Mailing Address - Fax:
Practice Address - Street 1:6925 E 5TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3837
Practice Address - Country:US
Practice Address - Phone:480-695-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1919Other1919