Individual
BRIAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5535 PINETREE RD, PANAMA CITY, FL 32404-5164
(850) 257-6408
Mailing address
5535 PINETREE RD, PANAMA CITY, FL 32404-5164
(850) 257-6408
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-44656
FL
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-44656
BCBA
FL
Enumeration date
05/02/2016
Last updated
09/24/2020
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