NPIMap

Organization Active NPI

Unstuck Space PLLC

Doing business as Ellie Mental Health

  • Mental Health Counselor
  • Southlake, TX
National Provider Identifier
1164160099
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
UNSTUCK SPACE PLLC
Doing business as
Ellie Mental Health
Practice address
1835 E Southlake Blvd Ste 100
Southlake, TX 76092-7068
Phone
(817) 769-7687
NPI assigned
May 20, 2022
Last updated
Aug 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Authorized official

Name
Allyson StucklessNPI 1184247314
Title
Owner
Phone
(817) 915-4622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

1835 E Southlake Blvd Ste 100
Southlake, TX 76092-7068

Mailing address

1835 E Southlake Blvd Ste 100
Southlake, TX 76092-7068
Phone (817) 769-7687

Other practice location 1

6628 Bryant Irvin Rd Ste 200
Ft Worth, TX 76132-4221
Phone (817) 886-4370

Other practice location 2

2670 Firewheel Dr Ste A
Flower Mound, TX 75028-7596
Phone (817) 663-7633

Other names 1

  • Ellie Mental Health Doing business as

National Provider Directory

National Provider Directory

Locations

1835 E Southlake Blvd
Southlake, TX 76092
Phone (817) 305-0050

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1164160099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 E SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927068",
            "telephone_number": "817-769-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 E SOUTHLAKE BLVD STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927068",
            "telephone_number": "817-769-7687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6628 Bryant Irvin Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Ft Worth",
            "state": "TX",
            "postal_code": "761324221",
            "country_code": "US",
            "telephone_number": "817-886-4370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2670 Firewheel Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Flower Mound",
            "state": "TX",
            "postal_code": "750287596",
            "country_code": "US",
            "telephone_number": "817-663-7633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNSTUCK SPACE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A",
        "authorized_official_last_name": "STUCKLESS",
        "authorized_official_first_name": "ALLYSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-915-4622"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.