Provider Demographics
NPI:1992584635
Name:ELLIS, MARTHA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
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 1:2501 OHIO DR APT 637
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3582
Mailing Address - Country:US
Mailing Address - Phone:409-200-0427
Mailing Address - Fax:
Practice Address - Street 1:305 S JUPITER RD STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3050
Practice Address - Country:US
Practice Address - Phone:214-785-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health