Provider Demographics
NPI:1568713659
Name:ELLIS, ASHLEY ELAINE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELAINE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 SANTA ROSA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1766
Mailing Address - Country:US
Mailing Address - Phone:530-229-7744
Mailing Address - Fax:530-229-7707
Practice Address - Street 1:3570 SANTA ROSA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1766
Practice Address - Country:US
Practice Address - Phone:530-229-7744
Practice Address - Fax:530-229-7707
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA96720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)