Provider Demographics
NPI:1982785184
Name:LABELLE, ELLEN R (MED)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:LABELLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E CACTUS RD STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7196
Mailing Address - Country:US
Mailing Address - Phone:602-861-9005
Mailing Address - Fax:
Practice Address - Street 1:3040 E CACTUS RD STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7196
Practice Address - Country:US
Practice Address - Phone:602-393-8271
Practice Address - Fax:602-218-6434
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0733101YP2500X
AZLMFT 0261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional