Provider Demographics
NPI:1124509971
Name:ELLIS GROUP COUNSELING
Entity type:Organization
Organization Name:ELLIS GROUP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-690-1512
Mailing Address - Street 1:880 PROSPECTOR TRL STE 100
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2700
Mailing Address - Country:US
Mailing Address - Phone:254-690-1512
Mailing Address - Fax:254-690-1532
Practice Address - Street 1:880 PROSPECTOR TRL STE 100
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2700
Practice Address - Country:US
Practice Address - Phone:254-690-1512
Practice Address - Fax:254-690-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty