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1316657349
MICHAEL ETHEN ELLISON
SANTA ROSA, CA
NPI
1316657349
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2022-11-30
Last Update Date
2022-11-30
Business Address
MICHAEL ETHEN ELLISON
2300 NORTHPOINT PKWY
SANTA ROSA, CA 95407-5004
Phone number: 707-571-8452
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Mailing Address
MICHAEL ETHEN ELLISON
2300 NORTHPOINT PKWY
SANTA ROSA, CA 95407-5004
Phone number: 707-571-8452
Copy
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