Provider Demographics
NPI:1386797892
Name:ELLIS, HEATHER LEIGH (LBSW)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HANCOCK
Mailing Address - Street 2:SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:989-797-3400
Mailing Address - Fax:989-797-3522
Practice Address - Street 1:3665 BAY RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2445
Practice Address - Country:US
Practice Address - Phone:989-799-6542
Practice Address - Fax:989-799-6681
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802084108171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator