Provider Demographics
NPI:1942983499
Name:GARRISON, ELLIE
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:GARRISON
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 1:15-2832 MAHIMAHI ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-9123
Mailing Address - Country:US
Mailing Address - Phone:505-330-5495
Mailing Address - Fax:
Practice Address - Street 1:17-550 VOLCANO HWY
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760
Practice Address - Country:US
Practice Address - Phone:808-563-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health