Tierra Ezell, ALC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

ALC04247 Issued in AL

Practice address

7643 Broome CT
Theodore, AL 36582-6312

Phone

(251) 402-9072

NPI assigned

Apr 21, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1467149104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7643 BROOME CT",
            "city": "THEODORE",
            "state": "AL",
            "postal_code": "365826312",
            "telephone_number": "251-402-9072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7643 BROOME CT",
            "city": "THEODORE",
            "state": "AL",
            "postal_code": "365826312",
            "telephone_number": "251-402-9072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZELL",
        "first_name": "TIERRA",
        "name_prefix": "Mrs.",
        "credential": "ALC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AL",
            "license": "ALC04247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Uyen Phuong DO, PHARMD
• Marcus Maurice Dryer
• Phillip Dueitt
• Kim Elizabeth Dyson, LPC
• Encore Rehabilitation Inc
• Vernell S Forman, MA./CCC/SLP
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• Fruit of the Spirit Home Health Care
• Fuller Rehabilitation and Consulting Services, Inc.
• Susan Marie Gillispie, FNP

• Mental Health Counselor in Theodore, AL
• Providers in Theodore, AL by specialty
• Mental Health Counselor in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; 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.