Healthcare Provider Details

I. General information

NPI: 1295043818
Provider Name (Legal Business Name): ELIZABETH GRAZIOLI TALBOT L.P.C., L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD 1450
TROY MI
48084-4736
US

IV. Provider business mailing address

888 W. BIG BEAVER RD. 1450
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-8644
  • Fax: 248-244-1330
Mailing address:
  • Phone: 248-244-8644
  • Fax: 248-244-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL1778658
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL1356631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: