Ellis, Nicole Renee

Ellis, Nicole Renee is an sole proprietor health care provider with primary practice located at 108 Christine Way , Elizabethtown KY 42701-9681. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Ellis, Nicole Renee can be contacted via phone (270) 312-2877.

Contact Information

Primary practice address
108 Christine Way Elizabethtown KY 42701-9681
Phone: (270) 312-2877
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 103828 Kentucky

Profile Details

NPI number 1164580106
LBN Legal business name Ellis, Nicole Renee
Credentials LPCC-S, NCC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 4th, 2006
Last updated Jul 21st, 2022 - about 3 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 1164580106 NPPES
Kentucky MEDICAID 30605018
Kentucky Other 000000498778

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