Audrene Ellis, PHD

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2211007 Issued in AR

Practice address

101 N Woodrow St
Little Rock, AR 72205-4341

Phone

(501) 265-0046

Fax

(501) 663-2234

NPI assigned

Oct 18, 2021

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 names 1

• Dr. Audren Janelle Ellis Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellspring Renewal CenterGroup PAC ID 1254778897, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Wellspring Renewal Center

  • Mental Health Counselor
  • Little Rock, AR
  • NPI 1053833939
  Medicare reassignment Care Compare group NPD
• Life Strategies Counseling, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Pocahontas, AR
  • NPI 1427656099
  NPD (past)

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1366105207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N WOODROW ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054341",
            "telephone_number": "501-265-0046",
            "fax_number": "501-265-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N WOODROW ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054341",
            "telephone_number": "501-265-0046",
            "fax_number": "501-663-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "AUDRENE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "P2211007",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2211007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREN",
            "last_name": "ELLIS",
            "middle_name": "JANELLE",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kizzy Elliott
• Naomi L Elliott, LCSW
• Robin Brown Elliott, PA
• Terrence Dione Elliott
• Trevae Elliott
• Brianna Janella Ellis
• Christopher Ellis
• Eileen Ellis, MD
• Elizabeth Kay Ellis, APRN
• Joshua C Ellis, MD, MPH

• Professional Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.