Provider Demographics
NPI:1750546271
Name:ELLERS, ROBERT A (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ELLERS
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12755 N NEW REFLECTION DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4395
Mailing Address - Country:US
Mailing Address - Phone:520-572-4248
Mailing Address - Fax:
Practice Address - Street 1:12279 W. GRIER RD.
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653
Practice Address - Country:US
Practice Address - Phone:520-682-4782
Practice Address - Fax:520-682-4818
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4040404103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool