Individual
DR. DIANE MARLENE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., LP
Contact information
Practice address
323 E GRAND ST, SPRINGFIELD, MO 65807-1447
(417) 761-5600
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2007033885
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497428003
—
MO
Enumeration date
06/15/2006
Last updated
09/28/2021
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