Provider Demographics
NPI:1891976874
Name:ELLIS, PHILLIP SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SCOTT
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BILTMORE AVE
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4501
Mailing Address - Country:US
Mailing Address - Phone:828-281-2299
Mailing Address - Fax:828-281-2299
Practice Address - Street 1:417 BILTMORE AVE
Practice Address - Street 2:SUITE 5D
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4501
Practice Address - Country:US
Practice Address - Phone:828-281-2299
Practice Address - Fax:828-281-2299
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2276103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000176Medicaid
NC2819937Medicare PIN