NPIMap

Organization Active NPI

Ellie PBC LLC

Doing business as Ellie Mental Health - Lake Worth Florida

  • Mental Health Counselor
  • Lake Worth, FL
National Provider Identifier
1942081872
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ELLIE PBC LLC
Doing business as
Ellie Mental Health - Lake Worth Florida
Practice address
2290 10TH Ave N Ste 601
Lake Worth, FL 33461-6618
Phone
(917) 855-2799
NPI assigned
Oct 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Authorized official

Name
Mr. Haaris Ali
Title
Owner
Phone
(630) 205-4664

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

2290 10TH Ave N Ste 601
Lake Worth, FL 33461-6618

Mailing address

2290 10TH Ave N Ste 201
Lake Worth, FL 33461-6609
Phone (630) 205-4664

Other names 1

  • Ellie Mental Health - Lake Worth Florida Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240216002685 FL Part B Supplier - Clinic/Group Practice 9436593563 Receives reassigned benefits from 13 practitioners
Practice locations: Lake Worth, FL

National Provider Directory

National Provider Directory

Locations

2290 10th Ave N
Ste 601
Lake Worth Beach, FL 33461
Phone (561) 823-3178

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1696550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1942081872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 10TH AVE N STE 201",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334616609",
            "telephone_number": "630-205-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 10TH AVE N STE 601",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334616618",
            "telephone_number": "917-855-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIE PBC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-06",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "HAARIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-205-4664",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health - Lake Worth Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.