CARILYN CLAIRE ELLIS (NPI# 1962888388) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962888388 |
| Entity Type | Individual |
| Full Name | CARILYN CLAIRE ELLIS |
| Credential | PSYD, MSCP |
| Practice Address |
3857 Wolverine St Ne Ste 6 Salem OR 97305-4274 |
| Mailing Address |
920 Sw Range Drive Waldport OR 97394-3035 |
| Practice Telephone | 5038566430 |
| Practice Fax Number | 5038771920 |
| Mailing Telephone | 5415633197 |
| Mailing Fax Number | 5415636027 |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2020-03-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 2595 | OR | Behavioral Health & Social Service Providers |
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
2595 | OR | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
2595 | OR | Behavioral Health & Social Service Providers |
| N | 103TP2701X |
Psychologist Specialization: Group Psychotherapy |
2595 | OR | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
2595 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE | R185419 | 01 |
| Street Address |
3857 WOLVERINE ST NE STE 6 |
| City | SALEM |
| State | OR |
| Zip Code | 97305-4274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689209371 | Autumn Leaf Therapeutic Services | Psychologist | 3857 Wolverine St Ne Ste 6, Salem, OR 97305-4274 | 2020-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821639147 | Christine Ann Featherstone | Social Worker | Chemawa Indian Health Center, 3750 Chemawa Road, Salem, OR 97305 | 2019-10-08 |
| 1962996553 | Erin Ann Wakefield | Non-emergency Medical Transport (VAN) | 2425 Fisher Rd Ne, Salem, OR 97305 | 2018-06-18 |
| 1770002271 | Traci L Lee | Case Manager/Care Coordinator | 3876 Beverly Ave Bldg G, Salem, OR 97305 | 2017-09-15 |
| 1952825762 | Matthew Paul Martin | Dentist | 2737 Lancaster Dr Ne Ste 150, Salem, OR 97305 | 2017-08-02 |
| 1043750367 | Sherri King | Physical Therapy Assistant | 4696 Reimann St Ne, Salem, OR 97305 | 2017-03-06 |
| 1760861314 | Amara Lenore Peterson | Counselor | 4347 Sunnyview Rd Ne, Salem, OR 97305 | 2015-05-28 |
| 1720467954 | Heather Rose | Community Health Worker | 4347 Sunnyview Road Ne, Salem, OR 97305 | 2015-05-20 |
| 1588057004 | Carmen Heidecke | Counselor | 4347 Sunnyview Rd. Ne, Salem, OR 97305 | 2015-03-08 |
| 1629476825 | Bryan James Greenaway | Audiologist | 3857 Wolverine St Ne Ste C-16, Salem, OR 97305 | 2014-12-21 |
| 1710300322 | Christopher Ryan | Counselor | 4385 Sunnyview Road Ne, Salem, OR 97305 | 2014-02-03 |
| Find all providers in zip 97305 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619583408 | Kyleemillerphd | Psychologist | 586 Welcome Way Se, Salem, OR 97302-3932 | 2020-09-17 |
| 1275196016 | Brittany Evelyn St. Jean | Psychologist | 27 Meisner Rd, Salem, NH 03079-2707 | 2019-04-17 |
| 1689162323 | Joyce Ann Perrotta | Psychologist | 57 Federal St, Salem, MA 01970-3436 | 2018-04-27 |
| 1851888119 | Muriel Portugal Rivera | Psychologist | 7 Lyme St, Salem, MA 01970-4817 | 2018-04-21 |
| 1568839298 | Katherine Russell | Psychologist | 10 Federal Street, Suite 307, Salem, MA 01970-5402 | 2015-08-28 |
| 1528300399 | Cassandra Sieg | Psychologist | 454 17th St Ne, Salem, OR 97301-4223 | 2013-03-20 |
| 1821335613 | Key Rehabilitation,inc. | Psychologist | 35625 Highway 72, Salem, MO 65560-7217 | 2013-01-14 |
| 1700170818 | David Cory Brillhart | Psychologist | 189 Liberty St., Ne, Suite 210a, The Reed Opera House, Salem, OR 97301 | 2011-06-06 |
| 1659517431 | Gerald Mark Farber | Psychologist | 50 Freedom Holw Unit 218, Salem, MA 01970-6626 | 2008-12-26 |
| 1740404193 | Anna Christine Linder | Psychologist | 1505 Water St Ne, Salem, OR 97303-6967 | 2007-04-13 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.