Individual
HEATHER ELLINGSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
723 E HIGHWAY 30, GONZALES, LA 70737-4715
(225) 743-2202
(225) 743-2028
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1503
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1503
STATE LICENSE
LA
05
—
2573713
—
LA
Enumeration date
03/20/2021
Last updated
06/16/2023
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