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Organization
KELLY A. ELLIS
Active
Organization
KELLY A. ELLIS
Active
Other names
Counseling & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY A ELLIS LCSW (OWNER)
(760) 832-4904
Entity
Organization
Contact information
Practice address
39760 BLACK MESA LN, PALM DESERT, CA 92260-1501
(760) 832-4904
Mailing address
PO BOX 2805, RANCHO MIRAGE, CA 92270-1099
(760) 832-4904
(760) 300-4060
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16686
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ28136Z
MEDICARE PTAN
CA
Enumeration date
06/24/2015
Last updated
08/01/2023
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