Mariah Ashley Ellis, LADC, LSW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305466 Issued in MN

Practice address

530 W Fir Ave
Fergus Falls, MN 56537-1364

Phone

(218) 998-8166

Fax

(218) 998-8150

NPI assigned

Jul 22, 2019

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

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.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1467283069
  NPD

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1700439403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 WESTVIEW AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371354",
            "telephone_number": "218-205-6483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 W FIR AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371364",
            "telephone_number": "218-998-8166",
            "fax_number": "218-998-8150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "721 S Minnesota St",
            "address_purpose": "LOCATION",
            "city": "Crookston",
            "state": "MN",
            "postal_code": "567161800",
            "country_code": "US",
            "telephone_number": "218-281-9511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Serenity Ln",
            "address_purpose": "LOCATION",
            "city": "Coburg",
            "state": "OR",
            "postal_code": "974089350",
            "country_code": "US",
            "telephone_number": "541-687-1110 x8708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARIAH",
        "middle_name": "ASHLEY",
        "credential": "LADC, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann Rae Ehlert, RN
• Dawson Eilts, PHARMD
• Lawrence F. Eisinger, MD
• Beca Tashlee Ellingson, PHARMD
• Danielle Elliott, MT
• David W Ellison, MD
• Rowan Elstrom
• Embrace Birth Care, LLC
• Erika Elvera Emery, D.C.
• Gabriel Dane Enderle, DDS

• Addiction (Substance Use Disorder) Counselor in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.