Provider Demographics
NPI:1376372904
Name:ELLS, BRANDY JEAN (MA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JEAN
Last Name:ELLS
Suffix:
Gender:X
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56413
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-1413
Mailing Address - Country:US
Mailing Address - Phone:907-687-0451
Mailing Address - Fax:
Practice Address - Street 1:315 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4837
Practice Address - Country:US
Practice Address - Phone:907-450-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)