Individual
TAMMY KENDAL ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3003 LOUISIANA BLVD NE, ALBUQUERQUE, NM 87110-2734
(505) 401-4088
(505) 899-4508
Mailing address
PO BOX 30742, ALBUQUERQUE, NM 87190-0742
(505) 401-4088
(505) 899-4508
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
X-06814
NM
Other
Enumeration date
11/24/2009
Last updated
07/21/2022
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