Individual
MS. ELLEN PATRICE SUMRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA PSYCHOLOGY
Contact information
Practice address
57 INDUSTRIAL PK RD, LUCEDALE, MS 39452
(228) 947-4274
(228) 947-4275
Mailing address
3855 LLEWELYN DR, MOBILE, AL 36608
(251) 342-7337
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
12/06/2006
Last updated
07/08/2007
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