Michelle Andree Ellis, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

AZ1319 Issued in AZ

Practice address

639 E Speedway
Tucson, AZ 85705

Phone

(520) 425-3456

Fax

(520) 319-9712

NPI assigned

Sep 26, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Deborah L Malone Lac LLC

  • Acupuncturist
  • Tucson, AZ
  • NPI 1720438088
  NPD (past)
• Mahnamana Psychotherapy and Meditation

  • Psychologist
  • Alameda, CA
  • NPI 1841951399
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1750482253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 E CORONADO",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857181514",
            "telephone_number": "520-425-3456",
            "fax_number": "520-319-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 E SPEEDWAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85705",
            "telephone_number": "520-425-3456",
            "fax_number": "520-319-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MICHELLE",
        "middle_name": "ANDREE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "1319",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "1319",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "AZ",
            "license": "1319",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "AZ",
            "license": "1319",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "AZ1319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "428799",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna R Ellis, CRNA
• Joanne Dee Ellis, LPC
• Kristen Ellis, RDN
• Kristen Elizabeth Ellis, PHARM.D
• Marcia K Ellis, PT
• Robert Ellis, OT/L, CHT
• Yaara Geva Ellis
• Isabella Rae Ellwanger
• Nermin Nader Elmakawey, MD
• Joseph John Elmer, P.T.

• Clinical Psychologist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.