| Ellie Mental Health | |
|
622 22nd St Ste 100 Galveston TX 77550-1900 | |
| (409) 220-6082 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 622 22nd St Ste 100, Galveston, Texas |
| Authorized Official Name and Position | Gerald Hanson (OWNER) |
| Authorized Official Contact | 8326184263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 622 22nd St Ste 100 Galveston TX 77550-1900 Ph: (409) 220-6082 | Ellie Mental Health 622 22nd St Ste 100 Galveston TX 77550-1900 Ph: (409) 220-6082 |
| NPI Number | 1174228803 |
|---|---|
| Provider Enumeration Date | 04/03/2023 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 4880035781 |
|---|---|
| Medicare Enrollment ID | O20240509001503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174228803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gerald D Hanson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811386261 PECOS PAC ID: 1254772163 Enrollment ID: I20240509002291 |
| Provider Name | Tammy Michelle Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942957352 PECOS PAC ID: 1557702321 Enrollment ID: I20240510000518 |
| Provider Name | Michelle Carter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265443147 PECOS PAC ID: 3072954981 Enrollment ID: I20240510001327 |
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