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General NPI Number Information
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NPI Number | 1629293352
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Entity Type | Individual
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Provider Name | ELANA GOELL-VARKOVITZKY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26111 W. 14 MILE ROAD SUITE LL3
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City | FRANKLIN VILLAGE
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State | MI
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Zip | 48025-1168
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Country | US
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Telephone | 248-737-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 6279 DAKOTA CIR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-1567
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Country | US
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Telephone | 248-865-1525
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301006995
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License Number State | MI
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