Provider Demographics
NPI:1457816530
Name:ERTEL, HALLIE MARIE (BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:MARIE
Last Name:ERTEL
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 LUNA BELLA LN APT 322
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5364
Mailing Address - Country:US
Mailing Address - Phone:757-375-3461
Mailing Address - Fax:
Practice Address - Street 1:1717 S ORANGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-567-5924
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst