Ellis, Jordan Michael
Ellis, Jordan Michael is an individual health care provider with primary practice located at 1100 Wilford Hall Loop Bldg. 4554, 59 Mdw/Gme, Jbsa Lackland, Jbsa Lackland TX 78236. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Ellis, Jordan Michael can be contacted via phone (210) 292-5972.Contact Information
Primary practice address
1100 Wilford Hall Loop Bldg. 4554, 59 Mdw/Gme, Jbsa Lackland
Jbsa Lackland TX 78236
Phone: (210) 292-5972
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Health | 103TH0004X | ||
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0810007310 | Virginia |
Profile Details
| NPI number | 1972167161 |
|---|---|
| LBN Legal business name | Ellis, Jordan Michael |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 24th, 2019 |
| Last updated | Dec 1st, 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.
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