Active NPI
Mattalue Ellis, M.A.
- School Psychologist
- Saint Louis, MO
National Provider Identifier
1851814644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 11960 Westline Industrial Dr
Saint Louis, MO 63146-3209 - Phone
- (314) 439-1949
- NPI assigned
- Jul 24, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | |||
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
11960 Westline Industrial Dr
Saint Louis, MO 63146-3209
Mailing address
11960 Westline Industrial Dr
Saint Louis, MO 63146-3209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500854400000",
"number": "1851814644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11960 WESTLINE INDUSTRIAL DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11960 WESTLINE INDUSTRIAL DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631463209",
"telephone_number": "314-439-1949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "MATTALUE",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-24",
"last_updated": "2017-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.