Individual
DR. GLENN THOMAS ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
815 2ND AVE NO, COLUMBUS, MS 39701
(662) 327-7388
(662) 329-1177
Mailing address
815 2ND AVE NORTH, COLUMBUS, MS 39701
(662) 327-7388
(662) 329-1177
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
105
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115223
—
MS
Enumeration date
10/10/2006
Last updated
07/08/2007
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