Provider Demographics
NPI:1821878919
Name:ELLISON MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:ELLISON MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-491-2651
Mailing Address - Street 1:530 OAK RIDGE WAY E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8417
Mailing Address - Country:US
Mailing Address - Phone:701-491-2651
Mailing Address - Fax:
Practice Address - Street 1:530 OAK RIDGE WAY E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8417
Practice Address - Country:US
Practice Address - Phone:701-491-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty