Jennifer Jeanne Ellis, M.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401013557 Issued in MI

Practice address

7745 Jonagold Dr SE
Grand Rapids, MI 49508-7602

Phone

(616) 970-4636

NPI assigned

Jul 29, 2010

Last updated

Nov 15, 2013By the provider in NPPES

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

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384473600000",
    "number": "1609180819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7745 JONAGOLD DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087602",
            "telephone_number": "800-435-2197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7745 JONAGOLD DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087602",
            "telephone_number": "616-970-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JENNIFER",
        "middle_name": "JEANNE",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-29",
        "last_updated": "2013-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401013557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eleanor Ellis
• Emily Rose Ellis, PT, DPT
• Emmy Ruth Ellis, MSW
• Jacqueline Ellis
• James R Ellis, MD
• Joseph M. Ellis, DDS
• Kurt Thomas Ellis, LLP
• Laura Ellis, RDN
• Leigh Ellis, LPC
• Philip Lee Ellis, PH.D.

• Mental Health Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; 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.