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NPI Code Detail

MEDICARE: JOHNNIE DANIEL EZELL

MEDICARE: JOHNNIE DANIEL EZELL
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
1101YP2500XProfessional Counselor2021010667MO
2101YM0800XMental Health CounselorP8611021AR

General Provider Information

NPI Number : 1437471299
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNIE DANIEL EZELL
Provider Business Mailing Address
First Line : 24 MILLS DR
Second Line :
City : BELLA VISTA
State : AR
Zip : 72714-6333
Country : US
Telephone Number : 479-466-4004
Fax Number :
Provider Business Practice Location Address
First Line : 1200 W WALNUT ST
Second Line : SUITE 1500
City : ROGERS
State : AR
Zip : 72756-3521
Country : US
Telephone Number : 479-636-0083
Fax Number : 479-636-0144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2010
Last Update Date : 10/09/2024

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Directions to “ JOHNNIE DANIEL EZELL ” Practice Location

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