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General NPI Number Information
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NPI Number | 1972864973
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Entity Type | Organization
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Legal Business Name | ELIZABETH GUEST LMSW,LLC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 7000 ROOSEVELT AVE
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City | ALLEN PARK
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State | MI
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Zip | 48101-2583
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Country | US
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Telephone | 734-777-7503
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Fax |
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Provider Business Mailing Address
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Address Line | 19900 SAVAGE RD
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City | BELLEVILLE
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State | MI
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Zip | 48111-9676
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Country | US
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Telephone | 734-777-7503
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH GUEST
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Credential | LMSW
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Telephone | 734-777-7503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801089752
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License Number State | MI
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