Individual
NICQUELETTE ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2830 W GRANDE BLVD APT 3102, TYLER, TX 75703-3392
(813) 919-5860
Mailing address
2830 W GRANDE BLVD APT 3102, TYLER, TX 75703-3392
(813) 919-5860
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
TX
Other
Enumeration date
07/18/2024
Last updated
10/08/2025
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