Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1114428091 |
---|---|
Provider Name | Dr. Keiah Ellis |
First Address | Shreveport, LA 71129-8811 |
Second Address | Shreveport, LA 71129-8811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 26/02/2018 |