Active NPI
Ellis Bernstein, PH.D.
- Counselor
- Mountain BRK, AL
National Provider Identifier
1003420563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- PSY004430
- Practice address
- 3336 E Briarcliff Rd
Mountain BRK, AL 35223-1307 - Phone
- (205) 478-9492
- NPI assigned
- Sep 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | PSY004430 | GA | Primary |
Addresses
Primary practice location
3336 E Briarcliff Rd
Mountain BRK, AL 35223-1307
Mailing address
3336 E Briarcliff Rd
Mountain BRK, AL 35223-1307
Phone (205) 478-9492
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY004430 | GA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1003420563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3336 E BRIARCLIFF RD",
"city": "MOUNTAIN BRK",
"state": "AL",
"postal_code": "352231307",
"telephone_number": "205-478-9492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3336 E BRIARCLIFF RD",
"city": "MOUNTAIN BRK",
"state": "AL",
"postal_code": "352231307",
"telephone_number": "205-478-9492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNSTEIN",
"first_name": "ELLIS",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-02",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "GA",
"license": "PSY004430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain BRK, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.