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General NPI Number Information
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NPI Number | 1205697620
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Entity Type | Individual
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Provider Name | LAUREN ELLIS LMSW, SSW
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Gender | Female
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 41700 GARDENBROOK RD STE 110
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City | NOVI
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State | MI
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Zip | 48375-1320
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Country | US
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Telephone | 248-496-9747
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 STOKER CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3454
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Country | US
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Telephone | 124-849-6974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801114938
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License Number State | MI
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