Provider Demographics
NPI:1790158467
Name:ELLIS, SIERRA (LCSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CROSLEY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2913
Mailing Address - Country:US
Mailing Address - Phone:318-325-1092
Mailing Address - Fax:719-767-5098
Practice Address - Street 1:101 CROSLEY ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-2913
Practice Address - Country:US
Practice Address - Phone:318-325-1092
Practice Address - Fax:318-325-1222
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5048C1041C0700X
LA12860104100000X, 1041C0700X
MSC101751041C0700X
171M00000X
COCSW.099284321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator