Healthcare Provider Details

I. General information

NPI: 1073984043
Provider Name (Legal Business Name): ELLIOTT & ASSOCIATES COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13095 GREAT OAKS LN
BURT MI
48417-2500
US

IV. Provider business mailing address

13095 GREAT OAKS LN
BURT MI
48417-2500
US

V. Phone/Fax

Practice location:
  • Phone: 989-737-2611
  • Fax:
Mailing address:
  • Phone: 989-737-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberB3879Q
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberB3879Q
License Number StateMI

VIII. Authorized Official

Name: MRS. LINDA DENISE MOTEN-ELLIOTT
Title or Position: CEO/FOUNDER
Credential: MS,LMSW,CAADC,CCS-M
Phone: 989-737-2611