Individual
JAMES BRADLEY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1306 67TH ST NW, FORT PAYNE, AL 35967-8306
(334) 425-4295
Mailing address
1306 67TH ST NW, FORT PAYNE, AL 35967-8306
(334) 425-4295
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4301C
AL
Other
Enumeration date
01/25/2020
Last updated
01/26/2020
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