Individual
DR. NICOLE RENEE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC-S, NCC
Contact information
Practice address
108 CHRISTINE WAY, ELIZABETHTOWN, KY 42701-9681
(270) 312-2877
Mailing address
108 CHRISTINE WAY, ELIZABETHTOWN, KY 42701
(270) 312-2877
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
103828
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000498778
ANTHEM
KY
05
—
30605018
—
KY
Enumeration date
12/04/2006
Last updated
07/21/2022
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