Provider Demographics
NPI:1215569348
Name:ELLIS, HARRI-ANN DONNA
Entity type:Individual
Prefix:
First Name:HARRI-ANN
Middle Name:DONNA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 GOLF CLUB RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7061
Mailing Address - Country:US
Mailing Address - Phone:360-259-5966
Mailing Address - Fax:
Practice Address - Street 1:729 DEVOE ST. SE.
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-259-5966
Practice Address - Fax:360-956-1170
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606034541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical