Provider Demographics
NPI:1942033840
Name:ELLIS, CHELSEA E (RBT-24-372929)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RBT-24-372929
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 MAHOGANY ROW SE APT D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3766
Mailing Address - Country:US
Mailing Address - Phone:740-501-1350
Mailing Address - Fax:
Practice Address - Street 1:3407 TRIANA BLVD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4641
Practice Address - Country:US
Practice Address - Phone:833-747-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-24-372929106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician