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General NPI Number Information
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NPI Number | 1053610782
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Entity Type | Organization
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Legal Business Name | ELLEN KEYT, PHD, PLLC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 26789 WOODWARD AVE STE 110
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1334
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Country | US
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Telephone | 313-492-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 13932 ARNOLD
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City | REDFORD
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State | MI
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Zip | 48239-2817
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Country | US
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Telephone | 313-492-0166
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ELLEN LOUISE KEYT
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Credential | PHD, LP
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Telephone | 313-492-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014137
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License Number State | MI
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