Individual
BETH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
404 HOLSTON DR, GREENEVILLE, TN 37743-3126
(423) 470-0346
Mailing address
404 HOLSTON DR, GREENEVILLE, TN 37743-3126
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3013231
—
TN
01
—
3697678
MEDICARE
TN
Enumeration date
08/29/2008
Last updated
08/29/2008
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