Active NPI
Mary Key Ellisor, LPC
- Mental Health Counselor
- Houston, TX
National Provider Identifier
1487120127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 75955
- Practice address
- 3880 Greenhouse Rd Ste 10
Houston, TX 77084-6793 - Phone
- (832) 779-1136
- NPI assigned
- Oct 21, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 75955 | TX | Primary |
Addresses
Primary practice location
3880 Greenhouse Rd Ste 10
Houston, TX 77084-6793
Mailing address
3880 Greenhouse Rd Ste 10
Houston, TX 77084-6793
Phone (832) 779-1136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 834460 | Other | TX | BCBS TEXAS |
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 |
|---|---|---|---|
| 75955 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554681600000",
"number": "1487120127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3880 GREENHOUSE RD STE 10",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770846793",
"telephone_number": "832-779-1136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3880 GREENHOUSE RD STE 10",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770846793",
"telephone_number": "832-779-1136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISOR",
"first_name": "MARY",
"middle_name": "KEY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-21",
"last_updated": "2019-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "75955",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TEXAS",
"identifier": "834460",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.