Irene Gutierrez Ellis, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3619 Issued in CO

Practice address

2101 S Blackhawk St., Ste 240, RM 4
Aurora, CO 80014-1475

Phone

(720) 316-5840

Fax

(720) 362-2435

NPI assigned

Jun 18, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442
  Medicare reassignment NPD

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584748800000",
    "number": "1619138070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 S SICILY ST",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800154599",
            "telephone_number": "303-883-1082",
            "fax_number": "720-362-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 S BLACKHAWK ST., STE 240, RM 4",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800141475",
            "telephone_number": "720-316-5840",
            "fax_number": "720-362-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "IRENE",
        "middle_name": "GUTIERREZ",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2020-03-21",
        "certification_date": "2020-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61452769",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William David Josiah Elliott
• Ashlie Amber Ellis
• Dawaune Latiefth Ellis
• Deion Ellis, MD
• Emily Parker Ellis, MOT, OTR/L
• Laura E Ellis
• Michelle Lorraine Ellis, NP
• Sarah Jean Ellis, NP
• Laura Ellison-Hutchinson, M.S.W., LCSW
• Haley Jeanne Ellison, RN

• Clinical Psychologist in Aurora, CO
• Providers in Aurora, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.