Active NPI
Sue Ellison
- Counselor
- O Fallon, MO
National Provider Identifier
1710237607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 001590
- Practice address
- 109 Church St
O Fallon, MO 63366-2894 - Phone
- (314) 540-1759
- NPI assigned
- Sep 18, 2012
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 001590 | MO | Primary |
Addresses
Primary practice location
109 Church St
O Fallon, MO 63366-2894
Mailing address
512 Oakton Ridge Court
Ballwin, MO 63021
Phone (314) 540-1759
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001590 | MO | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347926400000",
"number": "1710237607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 OAKTON RIDGE COURT",
"city": "BALLWIN",
"state": "MO",
"postal_code": "63021",
"telephone_number": "314-540-1759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 CHURCH ST",
"city": "O FALLON",
"state": "MO",
"postal_code": "633662894",
"telephone_number": "314-540-1759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "SUE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-18",
"last_updated": "2012-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MO",
"license": "001590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.