Individual
DR. JAMES STEPHEN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 684-2173
(601) 249-4234
Mailing address
1701 WHITE ST, MCCOMB, MS 39648-2711
(601) 684-2173
(601) 249-4234
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
30428
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0124731
—
MS
Enumeration date
07/10/2006
Last updated
07/08/2007
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