Provider Demographics
NPI:1316212913
Name:ELLIS, JENNIFER M (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2991
Mailing Address - Country:US
Mailing Address - Phone:609-413-6089
Mailing Address - Fax:
Practice Address - Street 1:1816 W POINT PIKE STE 209
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5696
Practice Address - Country:US
Practice Address - Phone:609-413-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor