Ellis, Marina J.

Ellis, Marina J. is an individual health care provider with primary practice located at 427 N Arthur Ave Ste B , Pocatello ID 83204-3006. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Ellis, Marina J. can be contacted via phone (208) 637-0334.

Contact Information

Primary practice address
427 N Arthur Ave Ste B Pocatello ID 83204-3006
Fax: (208) 237-9670
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X LCPC303 Idaho

Profile Details

NPI number 1528107158
LBN Legal business name Ellis, Marina J.
Credentials LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 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 1528107158 NPPES
Idaho Other Q3717 BLUE CROSS

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