Patricia Taylor Ellis, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LMSW-44545 Issued in ID

Practice address

3676 N Harbor LN Ste 100
Boise, ID 83703-6919

Phone

(208) 607-3503

NPI assigned

Jan 10, 2024

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Evergreen Wellness Endeavors LLC

  • Social Worker
  • Meridian, ID
  • NPI 1639971377
  NPD Authorized official
• Free Fallin LLC

  • Mental Health Counselor
  • Boise, ID
  • NPI 1932844131
  NPD (past)

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1467223305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 E ANTON ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466298",
            "telephone_number": "208-637-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 N HARBOR LN STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837036919",
            "telephone_number": "208-607-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "PATRICIA",
        "middle_name": "TAYLOR",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-44545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Ellis, LCSW
• Logan Ellis
• Madeline Ellis, LPC
• Natalie Ellis, LMT, PTA
• Nathan Cody Ellis, LCPC
• Staci Dawn Ellis, LMT
• Susie Ellis, CPM, LM
• Timothy J. Ellis, O.D.
• Wayne R. Ellis, D.D.S.
• Jason M Ellison, MD

• Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.