Healthcare Provider Details

I. General information

NPI: 1770276107
Provider Name (Legal Business Name): ELYSE FRANCES HUTCHESON PHD, DLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W LIBERTY ST
ANN ARBOR MI
48103-6560
US

IV. Provider business mailing address

7819 ANNAPOLIS ST
PORTAGE MI
49002-4375
US

V. Phone/Fax

Practice location:
  • Phone: 734-368-9691
  • Fax:
Mailing address:
  • Phone: 484-319-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004882
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: