Individual
FRED ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
525 ALEXANDER ST, JONESBORO, LA 71251-2001
(318) 259-4676
Mailing address
1000 CHINABERRY DR STE 900, BOSSIER CITY, LA 71111-2455
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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