Individual
MATTISON LANIER ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
8829 CENTRE ST, SUITE 105, SOUTHAVEN, MS 38671-2610
(662) 280-6777
(662) 280-6775
Mailing address
8829 CENTRE ST, SUITE 105, SOUTHAVEN, MS 38671-2610
(662) 280-6777
(662) 280-6775
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1112
MS
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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