Provider Demographics
NPI:1588116842
Name:ELLIS, KERI TAYLOR (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:TAYLOR
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4343 CONCOURSE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8672
Mailing Address - Country:US
Mailing Address - Phone:734-677-0200
Mailing Address - Fax:734-677-3310
Practice Address - Street 1:4343 CONCOURSE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8672
Practice Address - Country:US
Practice Address - Phone:734-677-0200
Practice Address - Fax:734-677-3310
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401013373101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional