Provider Demographics
NPI:1144331729
Name:ELLINGTON, SEAN WILLIAM (LPC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:WILLIAM
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7776 E VIA VENTANA NORTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6484
Mailing Address - Country:US
Mailing Address - Phone:520-661-6292
Mailing Address - Fax:520-495-1494
Practice Address - Street 1:502 WEST 29TH STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-838-3973
Practice Address - Fax:520-884-9521
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ741761Medicaid