Active NPI
Stacy Lynn Ellis, PSYD
- Psychologist
- Vancouver, WA
National Provider Identifier
1699062711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY60509345
- Practice address
- 2621 NE 134TH St Ste 340
Vancouver, WA 98686-3036 - Phone
- (360) 450-0140
- NPI assigned
- Jul 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY60509345 | WA | Primary |
Addresses
Primary practice location
2621 NE 134TH St Ste 340
Vancouver, WA 98686-3036
Mailing address
2204 SE 12TH Ave Apt C
Portland, OR 97214-5338
Phone (310) 991-5923
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60509345 | WA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurothryve | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Vancouver, WA
- NPI 1851835920
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1699062711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2204 SE 12TH AVE APT C",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972145338",
"telephone_number": "310-991-5923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2621 NE 134TH ST STE 340",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986863036",
"telephone_number": "360-450-0140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "STACY",
"middle_name": "LYNN",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-10",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY60509345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.