Mary Mae Ellison

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

3301 E 12TH St Ste 259
Oakland, CA 94601-2940

Phone

(510) 269-9030

NPI assigned

Feb 27, 2017

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667088000000",
    "number": "1851831754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 HUMPHREY DR APT D",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945851933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 E 12TH ST STE 259",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012940",
            "telephone_number": "510-269-9030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Alabama St",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945904446",
            "country_code": "US",
            "telephone_number": "510-318-6112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "MARY",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-27",
        "last_updated": "2022-10-30",
        "certification_date": "2022-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Ellis
• Senobia Frances Ellis
• Dimitrius Dean Ellisen
• Deone Ellison
• Kelsey Megan Ellison, CCC-SLP
• Tamara Abarca Ellsworth
• Russell Murray Ellyson, DO
• Ruby Elmer
• Jasmine Elmiari, PHARMD
• Elsa Pao OD Inc

• Counselor in Oakland, CA
• Providers in Oakland, CA by specialty
• Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2022; 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.