Anne Ellingson, PROVISIONAL

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

PAT-073 Issued in WY

Practice address

610 W Broadway Ave
Suite L1
Jackson, WY 83001-8213

Phone

(307) 733-3908

Fax

(307) 734-0017

NPI assigned

Dec 4, 2015

Last updated

Dec 4, 2015By the provider in NPPES

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

Opted out of Medicare

Yes, effective Mar 5, 2026 through Mar 5, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lupine Mental Health and Integrative Psychiatry LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, WY
  • NPI 1871103127
  NPD (past)
• TBT, LLC

  dba Teton Behavior Therapy

  • Community/Behavioral Health Agency
  • Jackson, WY
  • NPI 1407230766
  NPD (past)

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1841665668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11390",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830021390",
            "telephone_number": "307-733-3908",
            "fax_number": "307-734-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W BROADWAY AVE",
            "address_2": "SUITE L1",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018213",
            "telephone_number": "307-733-3908",
            "fax_number": "307-734-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "ANNE",
        "credential": "PROVISIONAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WY",
            "license": "PAT-073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elk Ridge Dental
• Elkridge Dental South LLC
• Samantha Elkrief, LCSW
• Julie Elledge, LMFT182
• Ellen Nolan, Aprn, PC
• Michael Enright, PHD, APRN
• Idel Enriquez
• Morgan Sterling Ercanbrack
• Brittney Espinoza, DDS
• Peter Michael Estay

• Addiction (Substance Use Disorder) Counselor in Jackson, WY
• Providers in Jackson, WY by specialty
• Addiction (Substance Use Disorder) Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.