Individual
MR. MARK DALTON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1418 FILLMORE ST, TWIN FALLS, ID 83301-3380
(208) 735-2237
Mailing address
1418 FILLMORE ST, TWIN FALLS, ID 83301-3380
(208) 735-2237
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-32484
ID
Other
Enumeration date
06/12/2012
Last updated
12/04/2013
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