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Organization
ELLIE MENTAL HEALTH OF ESTERO
Active
Organization
ELLIE MENTAL HEALTH OF ESTERO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS SILVA (MANAGING MEMBER)
(908) 432-4636
Entity
Organization
Contact information
Practice address
22904 LYDEN DR STE 104, ESTERO, FL 33928-7048
(908) 432-4636
Mailing address
22904 LYDEN DR UNIT 104, ESTERO, FL 33928-7048
(908) 432-4636
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/12/2022
Last updated
01/05/2026
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