Provider Demographics
NPI:1487914586
Name:ELLENS, JEFFREY K (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:ELLENS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E BABCOCK ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4820
Mailing Address - Country:US
Mailing Address - Phone:406-577-2410
Mailing Address - Fax:406-573-1070
Practice Address - Street 1:106 E BABCOCK ST STE 1B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4820
Practice Address - Country:US
Practice Address - Phone:406-577-2410
Practice Address - Fax:406-573-1070
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical