Ellis, Eddie

Ellis, Eddie is an sole proprietor health care provider with primary practice located at 420 Tierney Rd , Fort Worth TX 76112-6324. He recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Adult Development & Aging, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Ellis, Eddie can be contacted via phone (817) 534-5480.

Contact Information

Primary practice address
420 Tierney Rd Fort Worth TX 76112-6324
Phone: (817) 534-5480
Fax: (817) 534-4748
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Adult Development & Aging 103TA0700X
Behavioral Health & Social Service Providers / Health Service 103TH0100X
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X

Profile Details

NPI number 1841400132
LBN Legal business name Ellis, Eddie
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 23rd, 2007
Last updated Jul 8th, 2007 - about 17 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.

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