Individual
MYKAH ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1410 PICKWICK ST, SAVANNAH, TN 38372-3519
(731) 925-5054
(731) 925-5699
Mailing address
1410 PICKWICK ST, SAVANNAH, TN 38372-3519
(731) 925-5054
(731) 925-5699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6028
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q010331
—
TN
Enumeration date
02/14/2011
Last updated
11/07/2016
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