Individual
LARRY D. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2664 S HARPER RD, CORINTH, MS 38834-6723
(662) 287-4055
Mailing address
20 DEER TRAIL RD, SELMER, TN 38375-6695
(931) 209-0619
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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