Individual
DR. MICHELLE ANDREE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
639 E SPEEDWAY, TUCSON, AZ 85705
(520) 425-3456
(520) 319-9712
Mailing address
4040 E CORONADO, TUCSON, AZ 85718-1514
(520) 425-3456
(520) 319-9712
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1319
AZ
103TC0700X
Clinical Psychologist
1319
AZ
103TC0700X
Clinical Psychologist
Primary
AZ1319
AZ
103TC2200X
Clinical Child & Adolescent Psychologist
1319
AZ
103TS0200X
School Psychologist
1319
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428799
—
AZ
Enumeration date
09/26/2006
Last updated
10/27/2014
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