Ellis, Jon B

Ellis, Jon B is an sole proprietor health care provider with primary practice located at 206 Princeton Rd Suite 21, Johnson City TN 37601-2058. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ellis, Jon B can be contacted via phone (423) 282-8182.

Contact Information

Primary practice address
206 Princeton Rd Suite 21 Johnson City TN 37601-2058
Phone: (423) 282-8182
Fax: (423) 283-0031
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X P1437 Tennessee

Profile Details

NPI number 1346385978
LBN Legal business name Ellis, Jon B
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 21st, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346385978 NPPES
Tennessee Other 4019151 BCBS NUMBER
Tennessee MEDICAID 3689850 BCBS NUMBER

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