Individual
JON B ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
206 PRINCETON RD, SUITE 21, JOHNSON CITY, TN 37601-2058
(423) 282-8182
(423) 283-0031
Mailing address
206 PRINCETON RD, SUITE 21, JOHNSON CITY, TN 37601-2058
(423) 282-8182
(423) 283-0031
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P1437
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3689850
—
TN
01
—
4019151
BCBS NUMBER
TN
Enumeration date
02/21/2007
Last updated
07/09/2007
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