Active NPI
Christian Ezelle
- Behavior Technician
- Millbrook, AL
National Provider Identifier
1790410850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-225432
- Practice address
- 2050 Commerce St
Millbrook, AL 36054-4212 - Phone
- (334) 290-5095
- NPI assigned
- Jul 21, 2022
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-22-225432 | AL | Primary |
Addresses
Primary practice location
2050 Commerce St
Millbrook, AL 36054-4212
Mailing address
2751 Legends Pkwy PMB 102
Prattville, AL 36066
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-22-225432 | AL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridgeway ABA Therapy, LLC | Current | Accepting new patients |
Locations
2751 Legends Pkwy
Prattville, AL 36066
Phone (478) 972-6008
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1790410850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2751 LEGENDS PKWY PMB 102",
"city": "PRATTVILLE",
"state": "AL",
"postal_code": "36066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 COMMERCE ST",
"city": "MILLBROOK",
"state": "AL",
"postal_code": "360544212",
"telephone_number": "334-290-5095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZELLE",
"first_name": "CHRISTIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-21",
"last_updated": "2022-07-21",
"certification_date": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AL",
"license": "RBT-22-225432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Millbrook, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.