Provider Demographics
NPI:1144844994
Name:ELLIS, JOSHUAH (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:JOSHUAH
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 44TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-3305
Mailing Address - Country:US
Mailing Address - Phone:325-899-9778
Mailing Address - Fax:
Practice Address - Street 1:5701 AVENUE P
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3674
Practice Address - Country:US
Practice Address - Phone:325-899-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional