Individual
JESSE SEVERT ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
8120 PENN AVE S STE 270, BLOOMINGTON, MN 55431-1320
(800) 336-5973
(612) 234-4689
Mailing address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9253
(651) 631-8789
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/08/2008
Last updated
12/06/2023
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