Individual
AMANDA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1006 S DIVISION ST, CARTERVILLE, IL 62918-1539
(618) 519-9200
(618) 985-3774
Mailing address
109 CALIFORNIA ST, PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 519-9200
(618) 985-4635
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180.013503
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370915481007
—
IL
Enumeration date
09/07/2017
Last updated
02/20/2025
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