Diane Marlene Ellis, PSY.D., LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2007033885 Issued in MO

Practice address

323 E Grand St
Springfield, MO 65807-1447

Phone

(417) 761-5600

NPI assigned

Jun 15, 2006

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

Other identifiers 1

Other names 1

• Ms. Diane Marlene Bailey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1770527426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044264",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E GRAND ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658071447",
            "telephone_number": "417-761-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 E Bradford Pkwy",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658044264",
            "country_code": "US",
            "telephone_number": "417-761-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DIANE",
        "middle_name": "MARLENE",
        "name_prefix": "Dr.",
        "credential": "PSY.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2007033885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497428003",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "BAILEY",
            "middle_name": "MARLENE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James M Elliott, CRNA
• Jessica M Ellis-Hall, PSYD, PLP
• Joan Ellis-Young, LPC
• Anjuli Ellis, FNP
• Daniel William Ellis, M.S. L.P.C.
• Jeffrey Christian Ellis, PA-C
• Jessica Ellis, MHS, CCC-SLP
• Keith W. Ellis, MD
• Kelsey Ellis, DO
• Marcia Nichols Ellis, PLPC

• Clinical Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.