Individual
JASON DEAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1102 E MISSOURI AVE, PHOENIX, AZ 85014-2708
(602) 999-8389
(602) 613-4165
Mailing address
1102 E MISSOURI AVE, PHOENIX, AZ 85014-2708
(602) 999-8389
(602) 613-4165
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
LMFT15837
AZ
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
OTC13694
AZ
Other
Enumeration date
02/16/2023
Last updated
05/07/2025
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