Eddie Ellis, is a
Psychologist - Intellectual & Developmental Disabilities based in Fort Worth, Texas. Eddie Ellis is licensed to practice in * (Not Available) (license number ) and his current practice location is
420 Tierney Rd, Fort Worth, Texas. He can be reached at his office (for appointments etc.) via phone at
(817) 534-5480.
NPI number for Eddie Ellis is 1841400132 and his current mailing address is 420 Tierney Rd, Fort Worth, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1841400132.
Healthcare Provider's Profile
| Full Name | Eddie Ellis |
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| Gender | Male |
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| Speciality | Psychologist - Intellectual & Developmental Disabilities |
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| Location | 420 Tierney Rd, Fort Worth, Texas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1841400132
- Provider Enumeration Date: 05/23/2007
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Eddie Ellis such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1841400132 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 103TA0700X | Psychologist - Adult Development & Aging | (* (Not Available)) | Primary |
| 103TH0100X | Psychologist - Health Service | (* (Not Available)) | Primary |
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Eddie Ellis is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Eddie Ellis,
420 Tierney Rd,
Fort Worth, TX 76112-6324
Ph: (817) 534-5480 | Eddie Ellis,
420 Tierney Rd,
Fort Worth, TX 76112-6324
Ph: (817) 534-5480 |
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