Provider Demographics
NPI:1649050766
Name:HAIR, ELLEN GRACE (APCC, NCC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:GRACE
Last Name:HAIR
Suffix:
Gender:F
Credentials:APCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ASHLAND AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4359
Mailing Address - Country:US
Mailing Address - Phone:847-917-6629
Mailing Address - Fax:
Practice Address - Street 1:206 SACRAMENTO ST STE 204
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2633
Practice Address - Country:US
Practice Address - Phone:310-908-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12640101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor