Individual
KAYLA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
409 VANDIVER DR STE 201, COLUMBIA, MO 65202-3754
(573) 397-1746
Mailing address
409 VANDIVER DR BLDG 6, STE 201, COLUMBIA, MO 65202-3754
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2014027176
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285713289
—
MO
Enumeration date
08/10/2014
Last updated
03/17/2018
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