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General NPI Number Information
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NPI Number | 1598973182
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Entity Type | Individual
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Provider Name | ELLEN LORD RN,MA,CAC-R,CCM
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 1005 MAY ST STE A
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City | CHARLEVOIX
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State | MI
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Zip | 49720-9380
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Country | US
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Telephone | 231-883-7738
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Fax | 231-588-7030
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Provider Business Mailing Address
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Address Line | PO BOX 61 1005 MAY STREET, SUITE A
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City | CHARLEVOIX
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State | MI
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Zip | 49720-0061
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Country | US
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Telephone | 231-883-7738
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Fax | 231-588-7030
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 200695
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 4704083965
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 4704083965
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License Number State | MI
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