Provider Demographics
NPI:1457638231
Name:ELLENDER, ERNEST C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:C
Last Name:ELLENDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GABASSE ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4609
Mailing Address - Country:US
Mailing Address - Phone:985-991-4214
Mailing Address - Fax:
Practice Address - Street 1:309 GOODE ST STE 3E
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5423
Practice Address - Country:US
Practice Address - Phone:985-991-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical