Ellis, Mary Ann

Ellis, Mary Ann is an sole proprietor health care provider with primary practice located at 20114 E Pennsylvania Ave , Dunnellon FL 34432-6033. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / School, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / School is her primary health care specialty. Ellis, Mary Ann can be contacted via phone (352) 465-2444.

Contact Information

Primary practice address
20114 E Pennsylvania Ave Dunnellon FL 34432-6033
Phone: (352) 465-2444
Fax: (352) 465-7854
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X SS 830 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X SS830 Florida

Profile Details

NPI number 1295042869
LBN Legal business name Ellis, Mary Ann
Credentials ED.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 2nd, 2010
Last updated Apr 8th, 2020 - about 5 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 1295042869 NPPES
Florida MEDICAID 1639229362

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