Provider Demographics
NPI:1124862602
Name:ELLER, BRIANNA HUNTER (ED S, LPC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:HUNTER
Last Name:ELLER
Suffix:
Gender:F
Credentials:ED S, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 DOUBLE BRIDGE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-5830
Mailing Address - Country:US
Mailing Address - Phone:256-201-2601
Mailing Address - Fax:
Practice Address - Street 1:45 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1261
Practice Address - Country:US
Practice Address - Phone:334-245-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC04856101YM0800X
ALBLH-0115-4975101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty