Provider Demographics
NPI:1538345418
Name:ELLIS, DOREEN (LMFT)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 W HWY 89A STE 4
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5745
Mailing Address - Country:US
Mailing Address - Phone:928-301-1821
Mailing Address - Fax:928-301-1821
Practice Address - Street 1:1485 W HWY 89A STE 4
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5745
Practice Address - Country:US
Practice Address - Phone:928-301-1821
Practice Address - Fax:928-301-1821
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist