| Ellie Mental Health | |
|
3303 W 144th Ave Unit 204 Broomfield CO 80023-9601 | |
| (303) 437-0721 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 3303 W 144th Ave Unit 204, Broomfield, Colorado |
| Authorized Official Name and Position | Jill Krueger (OWNER) |
| Authorized Official Contact | 3034370721 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 1461 Eagleview Pl Erie CO 80516-4032 Ph: (303) 437-0721 | Ellie Mental Health 3303 W 144th Ave Unit 204 Broomfield CO 80023-9601 Ph: (303) 437-0721 |
| NPI Number | 1114640356 |
|---|---|
| Provider Enumeration Date | 09/22/2022 |
| Last Update Date | 04/13/2023 |
| Certification Date | 04/13/2023 |
| Medicare PECOS PAC ID | 8921463605 |
|---|---|
| Medicare Enrollment ID | O20230502002389 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114640356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lior Shpizer-daube |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376043216 PECOS PAC ID: 9537524210 Enrollment ID: I20230502002507 |
| Provider Name | Roni Ruiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164114724 PECOS PAC ID: 9436517372 Enrollment ID: I20230623003176 |
| Provider Name | Kemba Douglas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487206447 PECOS PAC ID: 0042668238 Enrollment ID: I20231129000508 |
| Provider Name | Amelia Bumgarner-young |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780826701 PECOS PAC ID: 7911362694 Enrollment ID: I20231130003096 |
| Provider Name | Marcy Lee Libeer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184804460 PECOS PAC ID: 3678924354 Enrollment ID: I20240106000572 |
| Provider Name | Clarissa Sueann Gallegos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255988598 PECOS PAC ID: 7618328998 Enrollment ID: I20240111000851 |
| Provider Name | Lauren E Gardner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598379638 PECOS PAC ID: 2860834470 Enrollment ID: I20240529000623 |
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