| Ellie Mental Health Avon | |
|
1928 S Dan Jones Rd Avon IN 46123-6678 | |
| (317) 854-8265 | |
| Not Available |
| Full Name | Ellie Mental Health Avon |
|---|---|
| Speciality | Social Worker |
| Location | 1928 S Dan Jones Rd, Avon, Indiana |
| Authorized Official Name and Position | Erin Masterson (PRESIDENT) |
| Authorized Official Contact | 3173400356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health Avon 10883 Red Sky Rd Fishers IN 46037-7100 Ph: (317) 340-0356 | Ellie Mental Health Avon 1928 S Dan Jones Rd Avon IN 46123-6678 Ph: (317) 854-8265 |
| NPI Number | 1588361067 |
|---|---|
| Provider Enumeration Date | 02/14/2023 |
| Last Update Date | 08/06/2023 |
| Certification Date | 08/06/2023 |
| Medicare PECOS PAC ID | 3779937552 |
|---|---|
| Medicare Enrollment ID | O20230927003220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588361067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Erika R Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881888055 PECOS PAC ID: 5193018927 Enrollment ID: I20160801001130 |
| Provider Name | Shelby Kennel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447011127 PECOS PAC ID: 5193178895 Enrollment ID: I20240130000811 |
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