Provider Demographics
NPI:1720209349
Name:ELLIS, WENDY (MC, LPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 E. SECOND ST.
Mailing Address - Street 2:SUITE #210
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:480-946-6997
Practice Address - Street 1:7301 E. SECOND ST.
Practice Address - Street 2:SUITE #210
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:480-946-6997
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0508101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor