Provider Demographics
NPI:1700924628
Name:ELLIS, LEAH ANN (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ANN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33082 FM 1575
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4169
Mailing Address - Country:US
Mailing Address - Phone:512-716-9245
Mailing Address - Fax:866-394-0482
Practice Address - Street 1:908 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2660
Practice Address - Country:US
Practice Address - Phone:512-716-9245
Practice Address - Fax:866-394-0482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health