Provider Demographics
NPI:1588386924
Name:ELLIS, SHELBY V (PLPC)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:V
Last Name:ELLIS
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 KLEINPETER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7816
Mailing Address - Country:US
Mailing Address - Phone:985-228-2651
Mailing Address - Fax:
Practice Address - Street 1:6472 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2265
Practice Address - Country:US
Practice Address - Phone:985-223-0161
Practice Address - Fax:985-223-0162
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health