Individual
SHANNON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 WOOD GLEN LN, COLUMBUS, MS 39705-3273
(662) 574-2150
Mailing address
75 WOOD GLEN LN, COLUMBUS, MS 39705-3273
(662) 574-2150
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6518C
AL
1041C0700X
Clinical Social Worker
Primary
C11725
MS
Other
Enumeration date
03/10/2022
Last updated
10/16/2025
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