Provider Demographics
NPI:1154434900
Name:CHISUM, ELLA MAE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:MAE
Last Name:CHISUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7065
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7065
Mailing Address - Country:US
Mailing Address - Phone:409-832-7444
Mailing Address - Fax:409-832-7410
Practice Address - Street 1:2628 MCFADDIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1621
Practice Address - Country:US
Practice Address - Phone:409-832-7444
Practice Address - Fax:409-832-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional