Provider Demographics
NPI:1255941373
Name:ELLIS, EMILY LYNDA JADE (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNDA JADE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MANOR PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4871
Mailing Address - Country:US
Mailing Address - Phone:603-634-8535
Mailing Address - Fax:
Practice Address - Street 1:2 MANOR PKWY STE 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4871
Practice Address - Country:US
Practice Address - Phone:603-634-8535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4681101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health