Provider Demographics
NPI:1861141277
Name:ELY, GABRIELLA MARIE
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARIE
Last Name:ELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:MARIE
Other - Last Name:ELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2060 N HIGH ST APT 337
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1162
Mailing Address - Country:US
Mailing Address - Phone:614-406-6740
Mailing Address - Fax:
Practice Address - Street 1:4664 LARWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3621
Practice Address - Country:US
Practice Address - Phone:614-487-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician