Individual
PHILIP LEE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
125 S PARK ST, STE 325, TRAVERSE CITY, MI 49684-3608
(231) 715-8466
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301005230
MI
Other
Enumeration date
06/23/2006
Last updated
09/19/2017
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