Provider Demographics
NPI:1497209530
Name:ELLISON, JAMES (MFT, LADAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MFT, LADAC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT, LADAC
Mailing Address - Street 1:2705 OAK LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-4816
Mailing Address - Country:US
Mailing Address - Phone:479-474-8084
Mailing Address - Fax:
Practice Address - Street 1:2705 OAK LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4816
Practice Address - Country:US
Practice Address - Phone:479-474-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR443L101YA0400X
NV00581-LC101YA0400X
NV2637106H00000X
ARM2210002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)