Individual
EDDIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 TIERNEY RD, FORT WORTH, TX 76112-6324
(817) 534-5480
(817) 534-4748
Mailing address
420 TIERNEY RD, FORT WORTH, TX 76112-6324
(817) 534-5480
(817) 534-4748
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
Other
Enumeration date
05/23/2007
Last updated
09/11/2025
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