Individual
JEREMY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2626 CHARLES DR, CHALMETTE, LA 70043-3779
(504) 278-4006
Mailing address
1000 CHINABERRY DR STE 900, BOSSIER CITY, LA 71111-2455
(504) 406-5030
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/19/2019
Last updated
11/09/2020
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