NPIMap

Organization Active NPI

Ellie Mental Health of Estero

  • Mental Health Counselor
  • Estero, FL
National Provider Identifier
1851029243
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ELLIE MENTAL HEALTH OF ESTERO
Practice address
22904 Lyden Dr Ste 104
Estero, FL 33928-7048
Phone
(908) 432-4636
NPI assigned
Aug 12, 2022
Reactivated
Aug 24, 2023
Last updated
Jan 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Marcus Silva
Title
Managing Member
Phone
(908) 432-4636

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

22904 Lyden Dr Ste 104
Estero, FL 33928-7048

Mailing address

22904 Lyden Dr Unit 104
Estero, FL 33928-7048
Phone (908) 432-4636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230602001757 FL Part B Supplier - Clinic/Group Practice 6002273216 Receives reassigned benefits from 13 practitioners
Practice locations: Estero, FL; Fort Myers, FL

National Provider Directory

National Provider Directory

Locations

22904 Lyden Dr
Ste 4
Estero, FL 33928

22904 Lyden Dr
Unit 104
Estero, FL 33928
Phone (239) 494-3951

14540 Hope Center Loop
Unit 210
Fort Myers, FL 33912

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1851029243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22904 LYDEN DR UNIT 104",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339287048",
            "telephone_number": "908-432-4636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22904 LYDEN DR STE 104",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339287048",
            "telephone_number": "908-432-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIE MENTAL HEALTH OF ESTERO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-12",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "deactivation_date": "2023-08-05",
        "reactivation_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "SILVA",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "908-432-4636"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.