Individual
NAYIVE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
104 S. MAIN STREET, JOHNSON, KS 67855
(620) 952-1738
(620) 492-3316
Mailing address
104 S. MAIN, PO BOX 637, JOHNSON, KS 67855-0637
(620) 952-1738
(620) 492-3316
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9639
KS
1041C0700X
Clinical Social Worker
Primary
4766
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201119110B
—
KS
Enumeration date
07/23/2015
Last updated
09/24/2018
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