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Contact Information

GLENN T ELLIS, PHD
815 2ND AVE NO
COLUMBUS, MS39701
 Phone: 662-327-7388
 Fax: 662-329-1177
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for GLENN T ELLIS · (Male)

NPI Number 1184712820
Status Active
Credentials PHD
Entity Individual
Enumeration date 10/10/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 105
  • MS Medicaid 00115223
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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