Provider Demographics
NPI:1114395282
Name:ELLIS, LEE WHETSTONE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:WHETSTONE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LEE
Other - Middle Name:ELLEN
Other - Last Name:WHETSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 N. MCKINLEY
Mailing Address - Street 2:SUITE 950
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:SUITE 950
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-993-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2231-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical