Provider Demographics
NPI:1376794354
Name:ELLIS, JESSE SEVERT (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:SEVERT
Last Name:ELLIS
Suffix:
Gender:M
Credentials:LMFT
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Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9253
Mailing Address - Fax:651-631-8789
Practice Address - Street 1:8120 PENN AVE S STE 270
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1320
Practice Address - Country:US
Practice Address - Phone:800-336-5973
Practice Address - Fax:612-234-4689
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-12-06
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health