Provider Demographics
NPI:1770191744
Name:CONLEY, EBONY (RBT)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79368 PLUMMERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2674
Mailing Address - Country:US
Mailing Address - Phone:757-648-0854
Mailing Address - Fax:
Practice Address - Street 1:79368 PLUMMERS CREEK DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-2674
Practice Address - Country:US
Practice Address - Phone:757-648-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-64138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst