Individual
MR. LARRY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.W.
Contact information
Practice address
11104 W MEADOW CREEK DR, MILWAUKEE, WI 53224-5053
(414) 461-3134
(414) 393-6222
Mailing address
11104 W MEADOW CREEK DR, MILWAUKEE, WI 53224-5053
(414) 461-3134
(414) 393-6222
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
129151-121
WI
Other
Enumeration date
04/08/2014
Last updated
04/08/2014
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