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Individual

MRS. SHANNON NICOLE ELLISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3121 BROOKLAWN CAMPUS DR, LOUISVILLE, KY 40218-1282
(502) 451-5177
Mailing address
4532 PULASKI CT, LOUISVILLE, KY 40245-1839

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
KY-1355
KY

Other

Enumeration date
01/31/2014
Last updated
01/31/2014
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