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General NPI Number Information
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NPI Number | 1073984043
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Entity Type | Organization
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Legal Business Name | ELLIOTT & ASSOCIATES COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 13095 GREAT OAKS LN
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City | BURT
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State | MI
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Zip | 48417-2500
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Country | US
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Telephone | 989-737-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 13095 GREAT OAKS LN
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City | BURT
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State | MI
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Zip | 48417-2500
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Country | US
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Telephone | 989-737-2611
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MRS. LINDA DENISE MOTEN-ELLIOTT
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Credential | MS,LMSW,CAADC,CCS-M
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Telephone | 989-737-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | B3879Q
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | B3879Q
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License Number State | MI
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