Individual
MANON ELLSWORTH
Active
Individual
MANON ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, MFT, LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
14663
CO
103TC0700X
Clinical Psychologist
14663
CO
103TC1900X
Counseling Psychologist
14663
CO
103TC2200X
Clinical Child & Adolescent Psychologist
14663
CO
103TF0000X
Family Psychologist
14663
CO
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487014205
—
MO
Enumeration date
03/07/2016
Last updated
01/25/2023
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