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Contact Information

ELLIS THERAPEUTIC SERVICES
16116 INVERRARY LN
BLOOMINGTON, IL61705-5580
 Phone: 309-830-3968
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Counselor

101Y00000X
 

Mental Health

101YM0800X
 

Pastoral

101YP1600X
 

Professional

101YP2500X
Indicates primary specialty

NPI Profile & details for ELLIS THERAPEUTIC SERVICES

NPI # 1609453307
LBN Legal business name ELLIS THERAPEUTIC SERVICES
Authorized official THELMA CARPENTER-ELLIS - (CEO/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/27/2021
Last updated 03/27/2021 - About 5 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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