Provider Demographics
NPI:1639824402
Name:ELLIS, DANIEL BYRON (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BYRON
Last Name:ELLIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2827
Mailing Address - Country:US
Mailing Address - Phone:916-729-9682
Mailing Address - Fax:
Practice Address - Street 1:106 E HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2827
Practice Address - Country:US
Practice Address - Phone:916-729-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204064101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health