Michelle Ellingham
Individual provider Active NPI Clinical Social Worker · Autin, TX
NPI 1225523988 · NPPES record last updated Jun 26, 2018
Key facts
- NPI
- 1225523988
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 61393 (TX)
- Practice address
- 4425 S Mopac Expy
Suite 503
Autin, TX 78735 - Phone
- (512) 270-1513
- NPI assigned
- Jun 26, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61393 | TX | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 61393 | TX | Yes |
Addresses
Primary practice location
4425 S Mopac Expy
Suite 503
Autin, TX 78735
Mailing address
2823 E Martin Luther King Jr Blvd Apt 1219
Austin, TX 78702-0030
Phone (512) 964-3477
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.