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General NPI Number Information
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NPI Number | 1447062666
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Entity Type | Organization
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Legal Business Name | ELYSIAN MINDSCAPE XXII
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 17 E MARKET ST STE 112
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City | YORK
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State | PA
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Zip | 17401-1266
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Country | US
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Telephone | 717-472-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 2708 SUNSET LN
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City | YORK
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State | PA
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Zip | 17408-9565
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Country | US
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Telephone | 717-819-8581
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | DR. VANAY LAHSON FREDERICK-ELLIS
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Credential |
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Telephone | 717-472-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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