Provider Demographics
NPI:1982143350
Name:ELLIS, KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 RUFE SNOW DR
Mailing Address - Street 2:STE 304
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6684
Mailing Address - Country:US
Mailing Address - Phone:817-576-2447
Mailing Address - Fax:844-273-0993
Practice Address - Street 1:5424 RUFE SNOW DR
Practice Address - Street 2:STE 304
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6684
Practice Address - Country:US
Practice Address - Phone:817-576-2447
Practice Address - Fax:844-273-0993
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional