Individual
DEBRA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7340 KILBORN DR, FAIR OAKS, CA 95628-3336
(707) 484-2276
(916) 974-7851
Mailing address
10910 PINE VIEW HEIGHTS RD, NEVADA CITY, CA 95959-2618
(916) 390-5816
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT18954
CA
Other
Enumeration date
07/03/2014
Last updated
08/08/2019
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