Provider Demographics
NPI:1437486180
Name:NATIONAL EDUCATIONAL TRAINING SYSTEMS
Entity Type:Organization
Organization Name:NATIONAL EDUCATIONAL TRAINING SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ELLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-365-8522
Mailing Address - Street 1:376 AUTUMN TRL
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-4191
Mailing Address - Country:US
Mailing Address - Phone:727-365-8522
Mailing Address - Fax:866-799-3496
Practice Address - Street 1:376 AUTUMN TRL
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-4191
Practice Address - Country:US
Practice Address - Phone:727-365-8522
Practice Address - Fax:866-799-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY3273103T00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty