Provider Demographics
NPI:1376821967
Name:ELLIS, CATHERINE LEE (BA, MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LEE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:BA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 ELSMERE PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1405
Mailing Address - Country:US
Mailing Address - Phone:859-225-3812
Mailing Address - Fax:
Practice Address - Street 1:629 ELSMERE PARK
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1405
Practice Address - Country:US
Practice Address - Phone:859-225-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-34201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical