Most Relevant Information
Provider Data
| NPI Number: | 1003420563 |
| Provider Name: | ELLIS BERNSTEIN PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | PSY004430 |
Most Important Dates
| Enumeration Date: | 09/02/2020 |
| Last Updated: | 09/02/2020 |
Provider Practice Location
3336 E BRIARCLIFF RD
MOUNTAIN BRK
AL
352231307
Practice Location Phone/Fax
| Phone: | 2054789492 |
| Fax: |
Provider Mailing Location
3336 E BRIARCLIFF RD
MOUNTAIN BRK
AL
352231307
Provider Mailing Phone/Fax
| Phone: | 2054789492 |
| Fax: |