Individual
MS. KHALIHAH ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
980 FAIRWOOD DR, GRENADA, MS 38901-3609
(662) 230-2144
Mailing address
980 FAIRWOOD DR, GRENADA, MS 38901-3609
(662) 230-2144
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1108804
—
LA
Enumeration date
01/23/2018
Last updated
09/17/2018
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