Jacquelyn L Ellis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2440-C Issued in NV

Practice address

3122 Anchorman Way
North Las Vegas, NV 89031-0558

Phone

(702) 651-0911

NPI assigned

Oct 28, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• The Light House of Love

  • Community/Behavioral Health Agency
  • North Las Vegas, NV
  • NPI 1871822197
  NPD
• The Lighthouse of Love

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1417579749
  NPD

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

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1376879155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 ANCHORMAN WAY",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890310558",
            "telephone_number": "702-651-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3122 ANCHORMAN WAY",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890310558",
            "telephone_number": "702-651-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JACQUELYN",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-28",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "2440-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikell Elliott
• Tiffany Elliott
• Brianna Emily Ellis Calderon
• Velma Ellis-Grubbs
• Nyesha Ellis-Williams
• James William Ellis
• Jessica Ellis
• Melissa Roseanna Ellis
• Shanice Latae Ellis, CNA
• Sharron Ellis

• Clinical Social Worker in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.