Shannon Ellis
Social Worker, Clinical in Columbus, MS. Individual provider (NPI-1).
NPI number1417604331
StatusActive
Last updated in NPPESOct 16, 2025
Details
- NPI
- 1417604331
- Entity type
- Individual (NPI-1)
- Name
- Shannon Ellis
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 10, 2022
- Certification date
- Oct 16, 2025
- Last updated
- Oct 16, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | C11725 | MS | Yes |
| 1041C0700X | Social Worker, Clinical | 6518C | AL |
Practice location
75 Wood Glen LnColumbus, MS 39705-3273
Phone 662-574-2150
Mailing address
75 Wood Glen LnColumbus, MS 39705-3273
Phone 662-574-2150
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