Healthcare Provider Details

I. General information

NPI: 1376381764
Provider Name (Legal Business Name): ELLIE PHILLIPS BROWN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 HILLSHIRE MEADOW DR
MATTHEWS NC
28105-5294
US

IV. Provider business mailing address

1303 HILLSHIRE MEADOW DR
MATTHEWS NC
28105-5294
US

V. Phone/Fax

Practice location:
  • Phone: 980-339-3123
  • Fax:
Mailing address:
  • Phone: 980-339-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB959779
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: