Amberly Ellis, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC011633 Issued in GA

Practice address

1247 Tuscany Dr.
Suite B-1
Braselton, GA 30517

Phone

(678) 465-8665

NPI assigned

Apr 15, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Victory Child & Adolescent Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Braselton, GA
  • NPI 1922749837
  NPD Authorized official

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

{
    "created_epoch": "1523750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1639666704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 TUSCANY DR.",
            "address_2": "B-1",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "678-465-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 TUSCANY DR.",
            "address_2": "SUITE B-1",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "30517",
            "telephone_number": "678-465-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "AMBERLY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-15",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "APC009083",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC011633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amberly@thevictoriousmind.org",
            "affiliation": "N",
            "address_1": "1247 Tuscany Dr.",
            "address_2": "Suite B-1",
            "city": "Braselton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dr Sal PC
• Sandra Dufty, DPT
• Taylor Leigh Duncan, FNP-C
• Veronica Eberhart, AGACNP
• Thomas Ellington
• Shannon M Ellis, PTA
• Elizabeth Smith Elmadolar, FNP-BC
• Kayla W Emmett, PT, DPT
• Gemma P English, DPM
• Ifeoma Ezeh Omoregie, PA-C

• Mental Health Counselor in Braselton, GA
• Providers in Braselton, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; 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.