Individual
TINA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
229 A ST, MAGNOLIA, AR 71753-3653
(870) 367-2141
(870) 234-9481
Mailing address
602 N WALTON BLVD, BENTONVILLE, AR 72712-4576
(479) 271-6302
(479) 271-6307
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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