Provider Demographics
NPI:1396013827
Name:CARTER, ELLEN CHRISTY
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHRISTY
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 ALEGRIA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-3218
Mailing Address - Country:US
Mailing Address - Phone:936-446-9225
Mailing Address - Fax:
Practice Address - Street 1:2007 ALEGRIA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-3218
Practice Address - Country:US
Practice Address - Phone:936-446-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-11-9486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst