| Ellie Mental Health | |
|
5250 S 108th St Hales Corners WI 53130-1321 | |
| (414) 975-1316 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 5250 S 108th St, Hales Corners, Wisconsin |
| Authorized Official Name and Position | Colleen Alicia Christiansen (CLINIC DIRECTOR) |
| Authorized Official Contact | 4149751316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 5250 S 108th St Hales Corners WI 53130-1321 Ph: (414) 975-1316 | Ellie Mental Health 5250 S 108th St Hales Corners WI 53130-1321 Ph: (414) 975-1316 |
| NPI Number | 1386358596 |
|---|---|
| Provider Enumeration Date | 01/11/2023 |
| Last Update Date | 12/05/2023 |
| Certification Date | 12/05/2023 |
| Medicare PECOS PAC ID | 0143672741 |
|---|---|
| Medicare Enrollment ID | O20240119000477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386358596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kaitlin A Kroeger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336621978 PECOS PAC ID: 1658707682 Enrollment ID: I20200211000161 |
| Provider Name | Colleen Alicia Christiansen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477953057 PECOS PAC ID: 4789036385 Enrollment ID: I20240119000569 |
| Provider Name | Samantha Bartlett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437728862 PECOS PAC ID: 4789036229 Enrollment ID: I20240119001971 |
| Provider Name | Janis A Avalos Rios |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639563448 PECOS PAC ID: 2062855877 Enrollment ID: I20240208003131 |
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