Provider Demographics
NPI:1649214180
Name:ELLIS, LINDA GAYLE (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:LINDA
Middle Name:GAYLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N GARFIELD ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6400
Mailing Address - Country:US
Mailing Address - Phone:432-570-0096
Mailing Address - Fax:432-682-1442
Practice Address - Street 1:3000 N GARFIELD ST
Practice Address - Street 2:SUITE 215
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6400
Practice Address - Country:US
Practice Address - Phone:432-570-0096
Practice Address - Fax:432-682-1442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical