Active NPI
Monifa Ellisaddie, LMFT
- Marriage & Family Therapist
- Locust Grove, GA
National Provider Identifier
1184337941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 132372
- Practice address
- 1012 Battersea PL
Locust Grove, GA 30248-2077 - Phone
- (818) 925-0569
- NPI assigned
- Dec 26, 2022
- Last updated
- Dec 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 132372 | CA | Primary |
Addresses
Primary practice location
1012 Battersea PL
Locust Grove, GA 30248-2077
Mailing address
1012 Battersea PL
Locust Grove, GA 30248-2077
Phone (908) 644-4830
Other practice location 1
11825 Magnolia Blvd Apt 109
Valley Village, CA 91607-2873
Phone (818) 925-0569
Other names 1
- Monifa Ellis
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.theranest.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 132372 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672012800000",
"number": "1184337941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 BATTERSEA PL",
"city": "LOCUST GROVE",
"state": "GA",
"postal_code": "302482077",
"telephone_number": "908-644-4830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 BATTERSEA PL",
"city": "LOCUST GROVE",
"state": "GA",
"postal_code": "302482077",
"telephone_number": "818-925-0569"
}
],
"practiceLocations": [
{
"address_1": "11825 Magnolia Blvd Apt 109",
"address_purpose": "LOCATION",
"city": "Valley Village",
"state": "CA",
"postal_code": "916072873",
"country_code": "US",
"telephone_number": "818-925-0569",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLISADDIE",
"first_name": "MONIFA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-12-26",
"last_updated": "2022-12-26",
"certification_date": "2022-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "132372",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.theranest.com",
"affiliation": "N",
"endpointDescription": "Client portal",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1012 Battersea Pl",
"city": "Locust Grove",
"state": "GA",
"country_code": "US",
"postal_code": "302482077",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "MONIFA",
"last_name": "ELLIS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Locust Grove, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.