Brandi Michelle Ellis, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2281 Issued in AL

Practice address

930 20TH St S
Birmingham, AL 35205-2610

Phone

(205) 934-5471

NPI assigned

Jul 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Will's Way, LLC

  • Psychologist
  • Hattiesburg, MS
  • NPI 1952673915
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1184110520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 2ND AVENUE SOUTH, CH19 SUITE 307",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352942041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 20TH ST S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352052610",
            "telephone_number": "205-934-5471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 Millbranch Rd Ste 1200",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394021594",
            "country_code": "US",
            "telephone_number": "601-255-5264",
            "fax_number": "866-625-0559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRANDI",
        "middle_name": "MICHELLE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "2281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul F. Elliott, M.D.
• Pierce Decker Elliott, DO
• Leesha Michelle Ellis-Cox, MD, MPH
• Beth Taylor Ellis, CRNP
• Blakely Ellis, AUD
• Brennan Phillip Ellis, CRNP
• Charles H. Ellis, DMD
• Frank Ellis, AGACNP
• Jack Ellis, P.T.
• Kelli S Ellis, M.S. CCC-SLP

• Clinical Psychologist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Clinical Psychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.