Individual
MS. DANIELLE PROMISE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AS, CADC I
Contact information
Practice address
557 NW MONROE AVE, CORVALLIS, OR 97330-4721
(541) 766-3540
(541) 766-3543
Mailing address
557 NW MONROE AVE, CORVALLIS, OR 97330-4721
(541) 766-3540
(541) 766-3543
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-01-44
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-01-44
MHACBO
OR
05
—
18-01-44
—
OR
Enumeration date
02/07/2019
Last updated
02/07/2019
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