Healthcare Provider Details

I. General information

NPI: 1689381055
Provider Name (Legal Business Name): ELANA MAIRE BAIOCCHI LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 W DICKMAN RD
SPRINGFIELD MI
49037-4895
US

IV. Provider business mailing address

1584 W KIRBY RD
BATTLE CREEK MI
49017-9059
US

V. Phone/Fax

Practice location:
  • Phone: 269-883-6560
  • Fax:
Mailing address:
  • Phone: 126-983-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: