MEDICARE: BEN DEBELL

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	101Y00000X	Counselor
2	101Y00000X	Counselor	3214	AL

General Provider Information

NPI Number	:	1972164622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN DEBELL

Provider Business Mailing Address
First Line	:	PO BOX 362084
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35236-2084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 ROCKY RIDGE RD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-5138
Country	:	US
Telephone Number	:	205-826-7462
Fax Number	:

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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Directions to “ BEN DEBELL ” Practice Location

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