Provider Demographics
NPI:1912997107
Name:ELLIS, LAURA PINE (MS)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:PINE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 LOCHMAN LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7652
Mailing Address - Country:US
Mailing Address - Phone:713-824-1402
Mailing Address - Fax:
Practice Address - Street 1:7400 FANNIN SUITE 1200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:832-398-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS