Amy C. Ellis

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH6475 Issued in FL

Legal business name

AMY C. ELLIS

Doing business as

Amy C. Ellis

Practice address

124 E Miracle Strip Pkwy Ste 602
Mary Esther, FL 32569-1991

Phone

(850) 243-8529

Fax

(850) 243-8529

NPI assigned

Jul 26, 2017

Organization subpart

No

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

Authorized official

Name

Amy EllisNPI 1396850988

Title

LMHC

Phone

(850) 243-7035

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Amy C. Ellis Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy Carol Ellis, L.M.H.C.

  • Mental Health Counselor
  • Pace, FL
  • NPI 1396850988
  NPD Authorized official

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1841714458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 ANNIE RUTH ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325708153",
            "telephone_number": "850-261-9032",
            "fax_number": "850-243-8529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E MIRACLE STRIP PKWY STE 602",
            "city": "MARY ESTHER",
            "state": "FL",
            "postal_code": "325691991",
            "telephone_number": "850-243-8529",
            "fax_number": "850-243-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMY C. ELLIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "LMHC",
        "authorized_official_telephone_number": "850-243-7035"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH6475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MH6475",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amy C. Ellis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Mary Esther, FL
• Providers in Mary Esther, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.