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1609311315
MICHAEL MARIO ELLIS
STOCKTON, CA
NPI
1609311315
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-01-04
Last Update Date
2017-01-04
Business Address
-- MICHAEL MARIO ELLIS
1222 MONACO CT #28
STOCKTON, CA 95207-6742
Phone number: 209-644-6328
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Mailing Address
-- MICHAEL MARIO ELLIS
1222 MONACO CT #28
STOCKTON, CA 95207-6742
Phone number: 209-644-6328
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