Ellis, Carilyn Claire
Ellis, Carilyn Claire is an sole proprietor health care provider with primary practice located at 3857 Wolverine St Ne Ste 6 , Salem OR 97305-4274. She recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Ellis, Carilyn Claire can be contacted via phone (503) 856-6430.Contact Information
Primary practice address
3857 Wolverine St Ne Ste 6
Salem OR 97305-4274
Phone: (503) 856-6430
Fax: (503) 877-1920
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | 2595 | Oregon |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 2595 | Oregon |
| Behavioral Health & Social Service Providers / Health | 103TH0004X | 2595 | Oregon |
| Behavioral Health & Social Service Providers / Group Psychotherapy | 103TP2701X | 2595 | Oregon |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 2595 | Oregon |
Profile Details
| NPI number | 1962888388 |
|---|---|
| LBN Legal business name | Ellis, Carilyn Claire |
| Credentials | PSYD, MSCP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 7th, 2015 |
| Last updated | Mar 5th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962888388 | NPPES |
| Oregon | Other | R185419 | MEDICARE |
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