Individual
TANYELL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 BELLE CHASSE HWY, GRETNA, LA 70053-6651
(504) 367-6630
Mailing address
2100 BELLE CHASSE HIGHWAY, GRETNA, LA 70053
(504) 493-9406
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15430
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/31/2019
Last updated
04/08/2020
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