Individual
TERRA L ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC, CMHT, CMA
Contact information
Practice address
719 EAST 11TH STREET, WILLISTON, ND 58801
(701) 572-6181
(701) 572-8783
Mailing address
PO BOX 2291, WILLISTON, ND 58802-2291
(701) 577-0270
(701) 577-0271
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1996
ND
171M00000X
Case Manager/Care Coordinator
—
ND
Other
Enumeration date
02/28/2020
Last updated
11/05/2024
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