David T. Ellis, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

988 Issued in WV

Practice address

211 Hunter Park
Laurel Ridge Psychological Associates
Princeton, WV 24740

Phone

(304) 487-6121

Fax

(304) 487-8741

NPI assigned

Nov 18, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Laurel Ridge Psychological Associates

  • Psychologist
  • Princeton, WV
  • NPI 1790845816
  Medicare reassignment Authorized official
• New Hope Hearing Solutions, LLC

  • Audiologist-Hearing Aid Fitter
  • Princeton, WV
  • NPI 1982277299
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1093043754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 HUNTER PARK",
            "address_2": "LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-487-6121",
            "fax_number": "304-487-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 HUNTER PARK",
            "address_2": "LAUREL RIDGE PSYCHOLOGICAL ASSOCIATES",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-487-6121",
            "fax_number": "304-487-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DAVID",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-18",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WV",
            "license": "988",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "WV",
            "license": "988",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Wilson Edwards, M.D.
• Elite Therapy Associates Inc
• Joe Carey Ellington Jr., PH.D., M.D.
• Christopher Matthew Elliott
• Marlena Elliott
• Heather Nicole Ellis
• Jordyn Ellis
• Kaitlin Kaye Ellis
• Tabatha Ellis, PRSS
• Amy England

• Clinical Psychologist in Princeton, WV
• Providers in Princeton, WV by specialty
• Clinical Psychologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.