Provider Demographics
NPI:1588878110
Name:ELLIS, RITA V (LCSW)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:V
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 POPLAR AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3213
Mailing Address - Country:US
Mailing Address - Phone:901-287-4700
Mailing Address - Fax:901-287-4701
Practice Address - Street 1:2400 POPLAR AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3213
Practice Address - Country:US
Practice Address - Phone:901-287-4700
Practice Address - Fax:901-287-4701
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health