Active NPI
Robert Daniel Ellis Jr., MA, LMFT
- Marriage & Family Therapist
- Kannapolis, NC
National Provider Identifier
1194153882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1539
- Practice address
- 715 Pine St
Kannapolis, NC 28081-4215 - Phone
- (704) 224-8606
- NPI assigned
- Oct 16, 2013
- Sex
- Male
- 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 | 1539 | NC | Primary |
Addresses
Primary practice location
715 Pine St
Kannapolis, NC 28081-4215
Mailing address
PO Box 858
Kannapolis, NC 28082-0858
Phone (704) 224-8606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1539 | NC | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381881600000",
"number": "1194153882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 858",
"city": "KANNAPOLIS",
"state": "NC",
"postal_code": "280820858",
"telephone_number": "704-224-8606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 PINE ST",
"city": "KANNAPOLIS",
"state": "NC",
"postal_code": "280814215",
"telephone_number": "704-224-8606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "ROBERT",
"middle_name": "DANIEL",
"name_suffix": "Jr.",
"credential": "MA, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-16",
"last_updated": "2013-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "NC",
"license": "1539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kannapolis, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.