Active NPI
Howland Hiram Ellis
- Clinical Social Worker
- Fort Walton Beach, FL
National Provider Identifier
1346355930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW2913
- Practice address
- 1015 Mar Walt Dr
Fort Walton Beach, FL 32547-6738 - Phone
- (850) 259-9501
- Fax
- (850) 994-6958
- NPI assigned
- Aug 21, 2006
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW2913 | FL | Primary |
Addresses
Primary practice location
1015 Mar Walt Dr
Fort Walton Beach, FL 32547-6738
Mailing address
5091 San Miguel St
Milton, FL 32583-5630
Phone (850) 259-9501
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW2913 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346355930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5091 SAN MIGUEL ST",
"city": "MILTON",
"state": "FL",
"postal_code": "325835630",
"telephone_number": "850-259-9501",
"fax_number": "850-994-6958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 MAR WALT DR",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325476738",
"telephone_number": "850-259-9501",
"fax_number": "850-994-6958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "HOWLAND",
"middle_name": "HIRAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW2913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.