Provider Demographics
NPI:1184788937
Name:ELLIS, SHERRY R (LCPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:R
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 BUTLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9306
Mailing Address - Country:US
Mailing Address - Phone:406-549-5511
Mailing Address - Fax:
Practice Address - Street 1:9199 BUTLER CREEK RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9306
Practice Address - Country:US
Practice Address - Phone:406-549-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health