Provider Demographics
NPI:1396801403
Name:ELLASON, JOAN WEATHERSBEE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:WEATHERSBEE
Last Name:ELLASON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 K AVE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5907
Mailing Address - Country:US
Mailing Address - Phone:469-831-4548
Mailing Address - Fax:726-121-9089
Practice Address - Street 1:101 E PARK BLVD
Practice Address - Street 2:SUITE #640
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5483
Practice Address - Country:US
Practice Address - Phone:469-831-4548
Practice Address - Fax:972-918-9069
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X
TX12612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028532201Medicaid
TXLP0053283Medicaid
TX222206Medicare UPIN
TX3198LCMedicare UPIN
TX5074159Medicare UPIN
TX1071920Medicare UPIN
TX116179Medicare UPIN
TX2037696Medicare UPIN
TXLP0053283Medicaid