Provider Demographics
NPI:1912376179
Name:ELLIS, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 EAGLE DR
Mailing Address - Street 2:APT 110
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6682
Mailing Address - Country:US
Mailing Address - Phone:817-676-1587
Mailing Address - Fax:
Practice Address - Street 1:723 S I 35 E
Practice Address - Street 2:SUITE 110
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4101
Practice Address - Country:US
Practice Address - Phone:940-483-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist