Provider Demographics
NPI:1588893010
Name:ELLISON, SEAN PATRICK (LCMHC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:ELLISON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:PATRICK
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:8285 SW NIMBUS AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6428
Mailing Address - Country:US
Mailing Address - Phone:503-610-2044
Mailing Address - Fax:
Practice Address - Street 1:8285 SW NIMBUS AVE STE 130
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6428
Practice Address - Country:US
Practice Address - Phone:503-610-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
NH1999101YM0800X
ORC5453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator