Individual
KATRINA L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
111 N HUDSON ST, ALTUS, OK 73521-3811
(580) 379-4085
(580) 379-4062
Mailing address
PO BOX 42, BLAIR, OK 73526-0042
(580) 480-5970
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5526
OK
101YP2500X
Professional Counselor
LPC005689
GA
Other
Enumeration date
04/10/2014
Last updated
04/02/2017
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