MEDICARE: EJM LEARNING SOLUTIONS, INC.

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	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1538503354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJM LEARNING SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	4851 CAHABA RIVER ROAD
Second Line	:	SUITE 129
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-970-2070
Fax Number	:	205-536-6553

Provider Business Practice Location Address
First Line	:	4851 CAHABA RIVER ROAD
Second Line	:	SUITE 129
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-970-2070
Fax Number	:	205-536-6553

Authorized Official
Title or Position	:	OWNER, PRESIDENT, EX. DIRECTOR
Name	:	MRS. MICHELLE YOUNG GIVAN
Credential	:
Telephone Number	:	205-970-2070

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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