Organization
ELLIS THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THELMA CARPENTER-ELLIS (CEO/OWNER)
(309) 830-3968
Entity
Organization
Contact information
Practice address
16116 INVERRARY LN, BLOOMINGTON, IL 61705-5580
(309) 830-3968
Mailing address
16116 INVERRARY LN, BLOOMINGTON, IL 61705-5580
(309) 830-3968
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
03/27/2021
Last updated
03/27/2021
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