Provider Demographics
NPI:1093094823
Name:BEVIS, ELLA BENNETT (LPC)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:BENNETT
Last Name:BEVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E MOBILE ST STE 307
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4757
Mailing Address - Country:US
Mailing Address - Phone:256-760-1211
Mailing Address - Fax:256-768-5288
Practice Address - Street 1:118 E MOBILE ST STE 307
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4757
Practice Address - Country:US
Practice Address - Phone:256-760-1211
Practice Address - Fax:256-768-5288
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional