Provider Demographics
NPI:1407271612
Name:REESMAN, ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:REESMAN
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 1:203 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-1261
Mailing Address - Country:US
Mailing Address - Phone:816-531-7737
Mailing Address - Fax:
Practice Address - Street 1:206 WEST 23RD STREET
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-1262
Practice Address - Country:US
Practice Address - Phone:816-531-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional