Individual
ALISA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2001 S WOODRUFF AVE, SUITE 6, IDAHO FALLS, ID 83404-6374
(208) 529-4673
(208) 529-4676
Mailing address
2001 S WOODRUFF AVE, SUITE 6, IDAHO FALLS, ID 83404-6374
(208) 529-4673
(208) 529-4676
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-3497
ID
Other
Enumeration date
01/07/2008
Last updated
01/07/2008
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