Provider Demographics
NPI:1588177380
Name:STROUD, ELLEN A (LPC-MSHP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:A
Last Name:STROUD
Suffix:
Gender:F
Credentials:LPC-MSHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BLOUNT ST
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1377
Mailing Address - Country:US
Mailing Address - Phone:650-678-4629
Mailing Address - Fax:
Practice Address - Street 1:241 BLOUNT ST
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1377
Practice Address - Country:US
Practice Address - Phone:650-678-4629
Practice Address - Fax:844-800-2735
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3870101Y00000X
TN10441133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty