Provider Demographics
NPI:1386538650
Name:ELLIS, CHRISTIN BAILEY (MS)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:BAILEY
Last Name:ELLIS
Suffix:
Gender:X
Credentials:MS
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1981 ROCK UNION RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7445
Mailing Address - Country:US
Mailing Address - Phone:207-450-4954
Mailing Address - Fax:
Practice Address - Street 1:1981 ROCK UNION RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-7445
Practice Address - Country:US
Practice Address - Phone:207-450-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist