Individual
ELLIE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4838 E BASELINE RD BLDG 3, MESA, AZ 85206-4671
(855) 223-7123
Mailing address
PO BOX 740780, ATLANTA, GA 30374-0780
(855) 223-7123
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/15/2026
Last updated
04/15/2026
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