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General NPI Number Information
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NPI Number | 1598645723
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Entity Type | Individual
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Provider Name | MISS MICHELLE NICOLE EZELL
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 1720 OAK VILLAGE BLVD STE 200B
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City | ARLINGTON
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State | TX
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Zip | 76017-7952
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Country | US
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Telephone | 682-282-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 E BROAD ST APT 2351
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City | MANSFIELD
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State | TX
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Zip | 76063-4763
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Country | US
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Telephone | 817-875-1579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202813
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License Number State | TX
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