Individual
TARA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIMHP
Contact information
Practice address
3677 N 129TH ST, OMAHA, NE 68164-5211
(573) 719-9655
Mailing address
3677 N 129TH ST, OMAHA, NE 68164-5211
(573) 719-9655
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
11803
NE
101Y00000X
Counselor
Primary
2529
NE
Other
Enumeration date
03/21/2019
Last updated
10/16/2023
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