Jill Ellingson, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

2671 Issued in MN

Practice address

445 Broadway Ave Ste a
St Paul Park, MN 55071

Phone

(612) 242-1224

Fax

(651) 340-2587

NPI assigned

Nov 15, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 1, 2025 through Feb 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Brave Soul Counseling Services, LLC

  • Marriage & Family Therapist
  • St Paul Park, MN
  • NPI 1457724205
  NPD Authorized official

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1851635973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 BROADWAY AVE STE A",
            "city": "ST PAUL PARK",
            "state": "MN",
            "postal_code": "550711554",
            "telephone_number": "612-242-1224",
            "fax_number": "651-340-2587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 BROADWAY AVE STE A",
            "city": "ST PAUL PARK",
            "state": "MN",
            "postal_code": "55071",
            "telephone_number": "612-242-1224",
            "fax_number": "651-340-2587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "JILL",
        "credential": "MA, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "2671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelina Davis
• Nicole Davis, MSW, LICSW, LADC
• Nikki Donnella Divirgilio, MSW, LGSW
• Dustin Dukart, D.C.
• Alissa Eischens, LICSW
• Evident Healthcare Management LLC
• Evident Social Services LLC
• Evident Transport LLC
• Gentle Comfort Home Care LLC
• Noor Haji-Munye

• Marriage & Family Therapist in St Paul Park, MN
• Providers in St Paul Park, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.