Mary Ann Ellis, ED.S.

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

SS 830 Issued in FL

Practice address

20114 E Pennsylvania Ave
Dunnellon, FL 34432-6033

Phone

(352) 465-2444

Fax

(352) 465-7854

NPI assigned

Sep 2, 2010

Last updated

Apr 8, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Growing Well Family Behavioral Services

  • School Psychologist
  • Dunnellon, FL
  • NPI 1639229362
  NPD Authorized official

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

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1295042869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20114 E PENNSYLVANIA AVE",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344326033",
            "telephone_number": "352-465-2444",
            "fax_number": "352-465-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20114 E PENNSYLVANIA AVE",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344326033",
            "telephone_number": "352-465-2444",
            "fax_number": "352-465-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "ED.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-02",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SS830",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS 830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639229362",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Dutkiewicz, LMT
• Stephanie Edworthy
• Kaitlyn Marie Eichler, APRN
• Adrienne Ellers, BCBA
• David Ellers
• Samantha Ellis, RBT
• Kylee Michelle Engle
• Gretchen English
• Essential Solutions Mental Health
• Extreme Infused Medical Plus (Coast to Coast Family Wellness)

• School Psychologist in Dunnellon, FL
• Providers in Dunnellon, FL by specialty
• School Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.