MEDICARE: WILLIAM EARL EZZELLE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	78816	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0718000610	VA
3	101YM0800X	Mental Health Counselor	37PC00934800	NJ
4	101YM0800X	Mental Health Counselor	6632	CT
5	101YM0800X	Mental Health Counselor	017135	NY
6	101YP2500X	Professional Counselor	37PC00934800	VA
7	101YM0800X	Mental Health Counselor	0701010791	VA
8	101YP2500X	Professional Counselor	0701010791	VA
9	101YP2500X	Professional Counselor	6632	CT
10	101YP2500X	Professional Counselor	78816	TX

General Provider Information

NPI Number	:	1013438555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EARL EZZELLE LPC

Provider Business Mailing Address
First Line	:	150 SOUTHFIELD AVE APT 2120
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-7764
Country	:	US
Telephone Number	:	276-415-0739
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 PALMERS HILL RD
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-2113
Country	:	US
Telephone Number	:	203-614-9942
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	03/25/2026

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Directions to “ WILLIAM EARL EZZELLE LPC” Practice Location

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