Individual
MR. JODY LEE ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5129 GALLOWAY ST, BELLEVUE, NE 68157-2422
(402) 201-0868
Mailing address
5129 GALLOWAY ST, BELLEVUE, NE 68157-2422
(402) 201-0868
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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