Individual
LISA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5300 ARSENAL ST, C166, SAINT LOUIS, MO 63139-1463
(314) 877-5789
Mailing address
5300 ARSENAL ST, C166, SAINT LOUIS, MO 63139-1463
(314) 877-5789
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01860
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499441608
—
MO
Enumeration date
10/10/2006
Last updated
08/11/2008
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