Provider Demographics
NPI:1265600670
Name:ELLISON, CHRISTOPHER BYOUS
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BYOUS
Last Name:ELLISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303A LEONA AVE
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447
Mailing Address - Country:US
Mailing Address - Phone:775-636-4793
Mailing Address - Fax:
Practice Address - Street 1:303 LEONA AVE APT A
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2748
Practice Address - Country:US
Practice Address - Phone:775-636-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor