Provider Demographics
NPI:1023157393
Name:SPENCE, ELLEN LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LOUISE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1107
Mailing Address - Country:US
Mailing Address - Phone:205-930-0475
Mailing Address - Fax:205-930-0475
Practice Address - Street 1:2117 16TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-5060
Practice Address - Country:US
Practice Address - Phone:205-933-9155
Practice Address - Fax:205-933-9155
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist