Provider Demographics
NPI:1316654973
Name:ELLIS, ASHLEY (LMHC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21727 76TH AVE W STE C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7549
Mailing Address - Country:US
Mailing Address - Phone:253-752-7320
Mailing Address - Fax:
Practice Address - Street 1:260 LOOKOUT PL STE 202
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4485
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61405603101YM0800X
FLMH21211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61405603OtherDEPARTMENT OF HEALTH
FLMH21211OtherDEPARTMENT OF HEALTH