Individual
MR. JEFFERY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 S PRESTON ST, LOUISVILLE, KY 40202-1716
(502) 583-3951
Mailing address
211 WHIPPOORWILL DR, LOUISVILLE, KY 40222-4837
(502) 403-5933
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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