Provider Demographics
NPI:1699361550
Name:WAHHAB, ELLEN MARIE (PPS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:WAHHAB
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 PEPPERTREE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2072
Mailing Address - Country:US
Mailing Address - Phone:714-262-9013
Mailing Address - Fax:
Practice Address - Street 1:8181 PEPPERTREE LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2072
Practice Address - Country:US
Practice Address - Phone:714-262-9013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180201329103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool