| Ellie Mental Health | |
|
12247 Stratford Dr Clive IA 50325-8147 | |
| (515) 393-6702 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 12247 Stratford Dr, Clive, Iowa |
| Authorized Official Name and Position | Sam Tierney (TREASURER) |
| Authorized Official Contact | 3198553549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 12247 Stratford Dr Clive IA 50325-8147 Ph: (515) 393-6702 | Ellie Mental Health 12247 Stratford Dr Clive IA 50325-8147 Ph: (515) 393-6702 |
| NPI Number | 1417653650 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 02/12/2024 |
| Certification Date | 02/12/2024 |
| Medicare PECOS PAC ID | 1850742586 |
|---|---|
| Medicare Enrollment ID | O20240108000922 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417653650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Darla Rae Krom |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578676128 PECOS PAC ID: 4688776461 Enrollment ID: I20070226000242 |
| Provider Name | Kathryn Elizabeth Sieck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083079438 PECOS PAC ID: 9830480664 Enrollment ID: I20160624001003 |
| Provider Name | Emilie Thompson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023480597 PECOS PAC ID: 7113376971 Enrollment ID: I20231206000705 |
| Provider Name | Bryan J Hall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730300336 PECOS PAC ID: 0648423095 Enrollment ID: I20240108003152 |
| Provider Name | Kate Bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073221420 PECOS PAC ID: 9335590066 Enrollment ID: I20240108003256 |
| Provider Name | Amanda Jane Rennolet |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750779732 PECOS PAC ID: 2769833409 Enrollment ID: I20240108003385 |
| Provider Name | Gryphan Douglas Lott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649840612 PECOS PAC ID: 5193169233 Enrollment ID: I20240216003042 |
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