Provider Demographics
NPI:1457073694
Name:UPSTATE ELLIE LLC
Entity Type:Organization
Organization Name:UPSTATE ELLIE LLC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-275-8421
Mailing Address - Street 1:430 WOODRUFF RD STE 450
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3443
Mailing Address - Country:US
Mailing Address - Phone:864-659-6670
Mailing Address - Fax:
Practice Address - Street 1:430 WOODRUFF RD STE 450
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3443
Practice Address - Country:US
Practice Address - Phone:864-275-8421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty