Organization
ELLIS CLINICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLA ELLIS LCSW (OWNER)
(773) 793-7147
Entity
Organization
Contact information
Practice address
2635 S WABASH AVE FL 3, CHICAGO, IL 60616
(773) 377-6141
Mailing address
PO BOX 361, BERWYN, IL 60402-0361
(773) 377-6141
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149018206
IL
1041C0700X
Clinical Social Worker
C008340
NC
Other
Enumeration date
10/02/2017
Last updated
05/13/2018
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