Grant J Ellis
Individual provider Active NPI Community/Behavioral Health Agency · West Terre Haute, IN
NPI 1346052966 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1346052966
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Practice address
- 10 N Church St
West Terre Haute, IN 47885-1202 - Phone
- (812) 201-5763
- NPI assigned
- Jan 21, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
10 N Church St
West Terre Haute, IN 47885-1202
Mailing address
10 N Church St
West Terre Haute, IN 47885-1202
Phone (812) 201-5763
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- Deana Conner
- Abbie Lynn Cooprider
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- Amy Funkhouser
- Stacy Lynn Griswold
- Catherine J Hadden
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All providers in West Terre Haute, IN · Community/Behavioral Health Agency in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2025. 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.