Provider Demographics
NPI:1194576967
Name:ELLIS AND ASSOCIATES PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:ELLIS AND ASSOCIATES PSYCHOTHERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-677-0200
Mailing Address - Street 1:4343 CONCOURSE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8672
Mailing Address - Country:US
Mailing Address - Phone:734-677-0200
Mailing Address - Fax:734-677-3310
Practice Address - Street 1:4343 CONCOURSE DR STE 250
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8672
Practice Address - Country:US
Practice Address - Phone:734-677-0200
Practice Address - Fax:734-677-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty