Individual
KURTIS ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
257 MAIN ST, BINGHAMTON, NY 13905-2522
(607) 629-6206
Mailing address
257 MAIN ST, BINGHAMTON, NY 13905-2522
(607) 629-6206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
105850
NY
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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