Individual
SPENCER L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
2808 S. PICHER ST., JOPLIN, MO 64803
(417) 347-7700
Mailing address
105 W CRESTWOOD DR, MONETT, MO 65708-9577
(417) 235-3001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1342
MO
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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