Individual
MARY ANN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
20114 E PENNSYLVANIA AVE, DUNNELLON, FL 34432-6033
(352) 465-2444
(352) 465-7854
Mailing address
20114 E PENNSYLVANIA AVE, DUNNELLON, FL 34432-6033
(352) 465-2444
(352) 465-7854
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SS830
FL
103TS0200X
School Psychologist
Primary
SS 830
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639229362
—
FL
Enumeration date
09/02/2010
Last updated
04/08/2020
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