| Ellie Mental Health | |
|
109 N Oakwood Ave Ste 105 Brandon FL 33510-4629 | |
| (904) 704-7575 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Social Worker |
| Location | 109 N Oakwood Ave Ste 105, Brandon, Florida |
| Authorized Official Name and Position | Adam Booth (OWNER) |
| Authorized Official Contact | 9047047575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 5668 Fishhawk Crossing Blvd # 142 Lithia FL 33547-5900 Ph: (904) 704-7575 | Ellie Mental Health 109 N Oakwood Ave Ste 105 Brandon FL 33510-4629 Ph: (904) 704-7575 |
| NPI Number | 1003522723 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 01/28/2023 |
| Certification Date | 01/28/2023 |
| Medicare PECOS PAC ID | 1759746423 |
|---|---|
| Medicare Enrollment ID | O20230502001860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003522723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katherine Melissa Blanken |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376890061 PECOS PAC ID: 9830554500 Enrollment ID: I20230502001933 |
| Provider Name | Erin T Mcmahon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073177135 PECOS PAC ID: 6608237276 Enrollment ID: I20230728001661 |
| Provider Name | Kelly Christina Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851953350 PECOS PAC ID: 5597111435 Enrollment ID: I20231027002834 |
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