Individual
MISS EMYLIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, ACSW
Contact information
Practice address
710 E 111TH PL, LOS ANGELES, CA 90059
(323) 233-0425
Mailing address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
06/26/2019
Last updated
08/28/2019
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