Provider Demographics
NPI:1437576667
Name:ELLERIE, KATHLEEN (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ELLERIE
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 MIDWAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3522
Mailing Address - Country:US
Mailing Address - Phone:214-417-2260
Mailing Address - Fax:
Practice Address - Street 1:14330 MIDWAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3522
Practice Address - Country:US
Practice Address - Phone:214-417-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3372171100000X
TXAC01537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist