| Ellie Mental Health | |
|
77 3rd St Ste 400 Monument CO 80132-8179 | |
| (719) 433-5710 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 77 3rd St Ste 400, Monument, Colorado |
| Authorized Official Name and Position | Sara Petrie (OWNER) |
| Authorized Official Contact | 7194335710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 15740 Paiute Cir Monument CO 80132-6092 Ph: (719) 433-5710 | Ellie Mental Health 77 3rd St Ste 400 Monument CO 80132-8179 Ph: (719) 433-5710 |
| NPI Number | 1255075040 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 6709222961 |
|---|---|
| Medicare Enrollment ID | O20240311000114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255075040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Secondary |
| Provider Name | Emily L Maney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518325018 PECOS PAC ID: 0042516346 Enrollment ID: I20160314000504 |
| Provider Name | Amber R James |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861128530 PECOS PAC ID: 0840636007 Enrollment ID: I20240311000236 |
| Provider Name | Carmina Blasko |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356601637 PECOS PAC ID: 0244676401 Enrollment ID: I20240311000332 |
| Provider Name | Samantha Susan Spencer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093280232 PECOS PAC ID: 0042656217 Enrollment ID: I20240311000588 |
| Provider Name | Emily Bready |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417683525 PECOS PAC ID: 4688112675 Enrollment ID: I20240821004313 |
| Provider Name | Lori-ann Mcconnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285487561 PECOS PAC ID: 1456890714 Enrollment ID: I20240829004632 |
| Provider Name | Fawnda Newton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164121596 PECOS PAC ID: 4486148657 Enrollment ID: I20251215002250 |
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