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General NPI Number Information
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NPI Number | 1891200671
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Entity Type | Individual
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Provider Name | JASON MICHAEL ELDRED MA, LPC, CRC
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Gender | Male
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 42500 HAYES RD STE 500
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6768
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Country | US
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Telephone | 586-828-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 BEDFORD RD
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1116
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Country | US
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Telephone | 586-335-1217
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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 | 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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