Provider Demographics
NPI:1821507351
Name:WOLF, ELLY G (MA, MFT)
Entity Type:Individual
Prefix:
First Name:ELLY
Middle Name:G
Last Name:WOLF
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MRS
Other - First Name:ELLY
Other - Middle Name:G
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:2550 HONOLULU AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1859
Mailing Address - Country:US
Mailing Address - Phone:818-802-7465
Mailing Address - Fax:
Practice Address - Street 1:2550 HONOLULU AVE STE 103
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1859
Practice Address - Country:US
Practice Address - Phone:818-802-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health