Individual
TIANA ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 LANE 12, LOVELL, WY 82431-9555
(307) 568-2020
Mailing address
116 S 3RD ST, PO BOX 351, GREYBULL, WY 82426
(307) 568-2020
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PPC-873
WY
101YP2500X
Professional Counselor
Primary
LPC-1623
WY
Other
Enumeration date
02/18/2015
Last updated
12/21/2016
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