Provider Demographics
NPI:1497813786
Name:ELLEN, THELMA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:R
Last Name:ELLEN
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 1:7815 CANDLEGREEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2708
Mailing Address - Country:US
Mailing Address - Phone:713-541-3730
Mailing Address - Fax:
Practice Address - Street 1:8303 SOUTHWEST FWY
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1600
Practice Address - Country:US
Practice Address - Phone:713-541-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1224101YP2500X
TX018591041C0700X
TX003480-034597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist