Provider Demographics
NPI:1053507376
Name:ELLIS, DANIELLE CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHRISTINE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 FM 1488 RD APT 223
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-6003
Mailing Address - Country:US
Mailing Address - Phone:713-594-0071
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S STE 575
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2913
Practice Address - Country:US
Practice Address - Phone:713-686-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional