Provider Demographics
NPI:1548098205
Name:ELLERS, ELAINE AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:AMANDA
Last Name:ELLERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5064 COCOA PALM WAY # CAUSA
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5149
Mailing Address - Country:US
Mailing Address - Phone:916-834-5797
Mailing Address - Fax:
Practice Address - Street 1:5064 COCOA PALM WAY # CAUSA
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5149
Practice Address - Country:US
Practice Address - Phone:916-834-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical