Individual
CRYSTAL DAWN ELLIS
Active
Individual
CRYSTAL DAWN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2022021360
MO
1041C0700X
Clinical Social Worker
21113
OK
1041C0700X
Clinical Social Worker
Primary
4761
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16130914
CAQH
—
Enumeration date
10/11/2012
Last updated
08/27/2024
Update your record
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