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Individual
SARA ELLIS
Active
Individual
SARA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669438115
—
OH
Enumeration date
08/24/2017
Last updated
11/14/2017
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