Ellis, Glenn Thomas

Ellis, Glenn Thomas is an individual health care provider with primary practice located at 815 2Nd Ave No , Columbus MS 39701. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Ellis, Glenn Thomas can be contacted via phone (662) 327-7388.

Contact Information

Primary practice address
815 2Nd Ave No Columbus MS 39701
Phone: (662) 327-7388
Fax: (662) 329-1177
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 105 Mississippi

Profile Details

NPI number 1184712820
LBN Legal business name Ellis, Glenn Thomas
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2006
Last updated Jul 8th, 2007 - about 19 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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Identifiers

StateTypeNumberIssuer
All States NPI 1184712820 NPPES
Mississippi MEDICAID 00115223

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