Provider Demographics
NPI:1124537006
Name:ELLIS, NATALIE ANNE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ALMOND TREE LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-1737
Mailing Address - Country:US
Mailing Address - Phone:850-714-7089
Mailing Address - Fax:
Practice Address - Street 1:404 ALMOND TREE LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-1737
Practice Address - Country:US
Practice Address - Phone:850-714-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician