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General NPI Number Information
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NPI Number | 1265258461
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Entity Type | Organization
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Legal Business Name | ELYSIAN THERAPEUTICS LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 250 ENGLAR RD STE 8
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City | WESTMINSTER
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State | MD
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Zip | 21157-2927
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Country | US
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Telephone | 443-487-9665
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Fax |
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Provider Business Mailing Address
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Address Line | 196 HOMESTEAD DR
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City | HANOVER
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State | PA
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Zip | 17331-8052
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Country | US
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Telephone | 443-487-9665
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KRYSTAL LYNN KOTACSKA
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Credential |
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Telephone | 443-487-6695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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