Provider Demographics
NPI:1902328149
Name:PYNES, ELLIE FOX (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:FOX
Last Name:PYNES
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S. BEVERLY DR. #412
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-553-7030
Mailing Address - Fax:
Practice Address - Street 1:300 S. BEVERLY DRIVE
Practice Address - Street 2:SUITE 412
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-553-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFT32138103TP0814X, 106H00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist