Provider Demographics
NPI:1568584209
Name:ELLIS, KRIS MICHELE (LPC, ATR, MA)
Entity Type:Individual
Prefix:MS
First Name:KRIS
Middle Name:MICHELE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC, ATR, MA
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:MICHELE
Other - Last Name:SNAYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, ATR, MA
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1539
Mailing Address - Country:US
Mailing Address - Phone:970-485-0447
Mailing Address - Fax:
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-1539
Practice Address - Country:US
Practice Address - Phone:970-485-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09-157101Y00000X
CO5479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor