Provider Demographics
NPI:1487372132
Name:BELLAIRE ELLIE CLINIC PC
Entity type:Organization
Organization Name:BELLAIRE ELLIE CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:ESCLOVON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:409-626-1329
Mailing Address - Street 1:6300 WEST LOOP S STE 110
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2919
Mailing Address - Country:US
Mailing Address - Phone:832-924-0348
Mailing Address - Fax:832-852-5754
Practice Address - Street 1:6300 WEST LOOP S STE 110
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2919
Practice Address - Country:US
Practice Address - Phone:832-924-0348
Practice Address - Fax:832-852-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty