Provider Demographics
NPI:1679265383
Name:PIERCE, ELLEN M (MHP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BARTON CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5472
Mailing Address - Country:US
Mailing Address - Phone:217-390-9650
Mailing Address - Fax:
Practice Address - Street 1:701 MONROE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2036
Practice Address - Country:US
Practice Address - Phone:217-294-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health