NPIMap

Organization Active NPI

Ellis Therapeutic Services

  • Counselor
  • Bloomington, IL
National Provider Identifier
1609453307
Registry record updated Mar 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
ELLIS THERAPEUTIC SERVICES
Practice address
16116 Inverrary LN
Bloomington, IL 61705-5580
Phone
(309) 830-3968
NPI assigned
Mar 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2021

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

Authorized official

Name
Thelma Carpenter-EllisNPI 1053527093
Title
Ceo/Owner
Phone
(309) 830-3968

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Pastoral CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP1600X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X

Addresses

Primary practice location

16116 Inverrary LN
Bloomington, IL 61705-5580

Mailing address

16116 Inverrary LN
Bloomington, IL 61705-5580
Phone (309) 830-3968

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1616803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616803200000",
    "number": "1609453307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16116 INVERRARY LN",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617055580",
            "telephone_number": "309-830-3968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16116 INVERRARY LN",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617055580",
            "telephone_number": "309-830-3968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-27",
        "last_updated": "2021-03-27",
        "certification_date": "2021-03-27",
        "status": "A",
        "authorized_official_last_name": "CARPENTER-ELLIS",
        "authorized_official_first_name": "THELMA",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "309-830-3968"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2021; 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.