| Ellie Mental Health | |
|
3585 N University Ave Bldg Suite300 Provo UT 84604-6601 | |
| (808) 782-7409 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 3585 N University Ave Bldg Suite300, Provo, Utah |
| Authorized Official Name and Position | Eric E Workman (OWNER/CEO) |
| Authorized Official Contact | 8087827409 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 55-463 Naniloa Loop Laie HI 96762-1126 Ph: (808) 782-7409 | Ellie Mental Health 3585 N University Ave Bldg Suite300 Provo UT 84604-6601 Ph: (808) 782-7409 |
| NPI Number | 1891419149 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 04/27/2023 |
| Certification Date | 04/27/2023 |
| Medicare PECOS PAC ID | 9931566288 |
|---|---|
| Medicare Enrollment ID | O20230601001940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891419149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alexander Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649713637 PECOS PAC ID: 5395102644 Enrollment ID: I20230605000972 |
| Provider Name | Michael Wesley Sherman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992081228 PECOS PAC ID: 5890158125 Enrollment ID: I20230901003136 |
| Provider Name | Yoshiko Miyake |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598836090 PECOS PAC ID: 0840639787 Enrollment ID: I20240411003534 |
| Provider Name | Dana Robison Emmons |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1255424610 PECOS PAC ID: 1052750916 Enrollment ID: I20240411004465 |
| Provider Name | Jennifer Roach |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003247677 PECOS PAC ID: 5294277026 Enrollment ID: I20240609000192 |
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