Premier Leadership Academy, in

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PREMIER LEADERSHIP ACADEMY, IN

Practice address

2049 Max Luther Dr NW
Suite a
Huntsville, AL 35810-3801

Phone

(256) 288-3281

Fax

(256) 288-3283

NPI assigned

Apr 8, 2015

Last updated

Apr 8, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kreslyn Nichole Kelley-Ellis, ED.D.

Title

President/Ceo

Phone

(256) 288-3281

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1396131108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2049 MAX LUTHER DR NW",
            "address_2": "SUITE A",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358103801",
            "telephone_number": "256-288-3281",
            "fax_number": "256-288-3283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2049 MAX LUTHER DR NW",
            "address_2": "SUITE A",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358103801",
            "telephone_number": "256-288-3281",
            "fax_number": "256-288-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER LEADERSHIP ACADEMY, IN",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-08",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "KELLEY-ELLIS",
        "authorized_official_first_name": "KRESLYN",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "256-288-3281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AL",
            "license": "LPC1530",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Huntsville, AL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.