Aimee Gibson Ellicott, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY11408 Issued in CA

Practice address

6310 San Vicente Blvd
Suite 350
Los Angeles, CA 90048-5426

Phone

(323) 934-8971

NPI assigned

Jan 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 CA

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

Clinical Psychologist

Education

University of California, Geffen School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Moon Senior Counseling of California LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1447678990
  NPD (past)

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558410324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485426",
            "telephone_number": "323-934-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD",
            "address_2": "SUITE 350",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485426",
            "telephone_number": "323-934-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLICOTT",
        "first_name": "AIMEE",
        "middle_name": "GIBSON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY11408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi Lou Ellenhorn, MD
• Michael James Eller, MD
• Piccera Tiffany Ellerby, LMFT
• Markesha Ellerson
• Gail Nelson Ellias, O.D.
• Ruth Ellingsen
• Sandra L Ellingson, NP
• Elliot P. Schlang DDS Inc.
• Viki Elliot
• Catherine Elliott

• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.