Provider Demographics
NPI:1689070609
Name:ELLSWORTH, ALLISON (LAMFT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S. GILBERT RD. #204
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3368
Mailing Address - Country:US
Mailing Address - Phone:480-507-8619
Mailing Address - Fax:480-507-8618
Practice Address - Street 1:943 S GILBERT RD STE 204
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4441
Practice Address - Country:US
Practice Address - Phone:480-507-8619
Practice Address - Fax:480-507-8618
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist