Provider Demographics
NPI:1932933744
Name:ELI, BILLY BLUE
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:BLUE
Last Name:ELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 UNION STREET
Mailing Address - Street 2:SUITE 201 #3
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 UNION STREET
Practice Address - Street 2:SUITE 201 #3
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027
Practice Address - Country:US
Practice Address - Phone:412-203-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health