Provider Demographics
NPI:1477750131
Name:RESCH, ELLEN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:E
Last Name:RESCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:SNEADS
Mailing Address - State:FL
Mailing Address - Zip Code:32460-3916
Mailing Address - Country:US
Mailing Address - Phone:850-593-5330
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:LANDIS HALL
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1107
Practice Address - Country:US
Practice Address - Phone:850-663-7706
Practice Address - Fax:850-663-7011
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4333103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic