Ellis Therapy & Fitness

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149013439 Issued in IL

Legal business name

ELLIS THERAPY & FITNESS

Practice address

16595 W Easton Ave
Prairie View, IL 60069-2744

Phone

(847) 242-1669

Fax

(815) 524-2271

NPI assigned

Jun 19, 2014

Last updated

Jun 19, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Debra Ellis, LCSW

Title

Licensed Clinical Social Worker

Phone

(847) 242-1669

Specialties & licenses 1

Addresses

Other names 1

• Debra Ellis Therapy Services Former legal business name

Locations

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1548674203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16595 W EASTON AVE",
            "city": "PRAIRIE VIEW",
            "state": "IL",
            "postal_code": "600692744",
            "telephone_number": "847-242-1669",
            "fax_number": "815-524-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16595 W EASTON AVE",
            "city": "PRAIRIE VIEW",
            "state": "IL",
            "postal_code": "600692744",
            "telephone_number": "847-242-1669",
            "fax_number": "815-524-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS THERAPY & FITNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "847-242-1669",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149013439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Debra Ellis Therapy Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Beyond Art Therapy & Counseling, PLLC
• Kathy A Miller, LCPC
• Catherine O'Keefe, D.V.M.
• Denise C Ramirez
• Nicholas James Slager

• Clinical Social Worker in Prairie View, IL
• Providers in Prairie View, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.