Provider Demographics
NPI:1821444928
Name:ELLETT, AMBERLEE (CMHC)
Entity Type:Individual
Prefix:
First Name:AMBERLEE
Middle Name:
Last Name:ELLETT
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 750362
Mailing Address - Street 2:
Mailing Address - City:TORREY
Mailing Address - State:UT
Mailing Address - Zip Code:84775-0362
Mailing Address - Country:US
Mailing Address - Phone:435-691-0206
Mailing Address - Fax:
Practice Address - Street 1:45 N STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1363
Practice Address - Country:US
Practice Address - Phone:435-691-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341335-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health