Provider Demographics
NPI:1255419685
Name:ELLIS, JOAN MARIE (MA, LPC, LCDC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 BLANCO RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4363
Mailing Address - Country:US
Mailing Address - Phone:210-525-1979
Mailing Address - Fax:210-344-9255
Practice Address - Street 1:7410 BLANCO RD
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4363
Practice Address - Country:US
Practice Address - Phone:210-525-1979
Practice Address - Fax:210-344-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1196101YA0400X
TX05287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health