DR. ELLEN S. BRACKUP PH.D.
NPI 1720109317
Psychologist in Atlanta, GA

Active since April 02, 2007Opted out of Medicare · through May 15, 2027
1251 APPLE VALLEY RD NE, ATLANTA, GA 30319(404) 231-4455 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Ellen S. Brackup Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ELLEN S. BRACKUP PH.D. (NPI 1720109317) is an individual psychologist in Atlanta, Georgia, licensed in Georgia (697) and active in the NPI registry since April 2007. She has opted out of Medicare through May 15, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1720109317
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. ELLEN S. BRACKUPCredential: PH.D.
Location Address1251 APPLE VALLEY RD NEAtlanta, GA 30319-5424
Mailing Address1251 Apple Valley Rd NeAtlanta, GA 30319-5424
Sole ProprietorYes
Enumeration DateApril 2, 2007
Last NPPES UpdateSeptember 11, 2025
NPI 1720109317 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in GA · 697
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 697 (GA)

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Ellen S. Brackup Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 15, 2015 through May 15, 2027.

Opt-Out Effective DateMay 15, 2015
Opt-Out In Effect ThroughMay 15, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellen Brackup's NPI number?

The NPI number for Ellen Brackup is 1720109317. It was assigned to this individual provider in the NPPES registry on April 2, 2007.

Where is Ellen Brackup located?

Ellen Brackup practices at 1251 Apple Valley Rd NE, Atlanta, GA 30319. The listed phone number is (404) 231-4455.

What is Ellen Brackup's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Ellen Brackup enrolled in Medicare?

No. Ellen Brackup has opted out of Medicare through May 15, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Ellen Brackup was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.