Provider Demographics
NPI:1174712517
Name:CLAUSS, ELLEN ELIZABETH (MA)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:CLAUSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 VIRGINIA ST NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4689
Mailing Address - Country:US
Mailing Address - Phone:505-296-4449
Mailing Address - Fax:505-296-0497
Practice Address - Street 1:2520 VIRGINIA ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4689
Practice Address - Country:US
Practice Address - Phone:505-296-4449
Practice Address - Fax:505-296-0497
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health