Provider Demographics
NPI:1215178827
Name:ELLIS, KATHERINE ELEANOR (PHD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELEANOR
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 TRACE MANOR LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4843
Mailing Address - Country:US
Mailing Address - Phone:865-591-1022
Mailing Address - Fax:
Practice Address - Street 1:5007 TRACE MANOR LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4843
Practice Address - Country:US
Practice Address - Phone:865-591-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist