NICQUELETTE ELLISON
NPI 1912745472
Psychologist in Tyler, TX

Active since July 18, 2024Opted out of Medicare · through Jan 13, 2028
2830 W GRANDE BLVD APT 3102, TYLER, TX 75703(813) 919-5860 Get Directions Write a Review

NPPES record last updated: October 8, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 8, 2025, Jul 18, 2024 (2 updates tracked since 2024).

About Nicquelette Ellison NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICQUELETTE ELLISON (NPI 1912745472) is an individual psychologist in Tyler, Texas and active in the NPI registry since July 2024. She has opted out of Medicare through January 13, 2028.

NPPES Registry Identity

NPI1912745472
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameNICQUELETTE ELLISON
Location Address2830 W GRANDE BLVD APT 3102Tyler, TX 75703-3392
Mailing Address2830 W Grande Blvd Apt 3102Tyler, TX 75703-3392 · (813) 919-5860
Sole ProprietorNo
Enumeration DateJuly 18, 2024
Last NPPES UpdateOctober 8, 20252 updates tracked since enumeration
NPPES CertifiedOctober 8, 2025
NPI 1912745472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
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.
2830 W GRANDE BLVD APT 3102, Tyler, TX 75703

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Nicquelette Ellison has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 13, 2026 through January 13, 2028.

Opt-Out Effective DateJanuary 13, 2026
Opt-Out In Effect ThroughJanuary 13, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicquelette Ellison's NPI number?

The NPI number for Nicquelette Ellison is 1912745472. It was assigned to this individual provider in the NPPES registry on July 18, 2024.

Where is Nicquelette Ellison located?

Nicquelette Ellison practices at 2830 W Grande Blvd Apt 3102, Tyler, TX 75703. The listed phone number is (813) 919-5860.

What is Nicquelette Ellison's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Nicquelette Ellison enrolled in Medicare?

No. Nicquelette Ellison has opted out of Medicare through January 13, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Nicquelette Ellison was last updated on October 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.