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
Phone: (208) 637-0334
Fax: (208) 237-9670
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528107158 | NPPES |
| Idaho | Other | Q3717 | BLUE CROSS |
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