MEDICARE: ELLIOTT & ASSOCIATES COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	B3879Q	MI
2	251S00000X	Community/Behavioral Health Agency	B3879Q	MI

General Provider Information

NPI Number	:	1073984043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIOTT & ASSOCIATES COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	13095 GREAT OAKS LN
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-2500
Country	:	US
Telephone Number	:	989-737-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	13095 GREAT OAKS LN
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-2500
Country	:	US
Telephone Number	:	989-737-2611
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MRS. LINDA DENISE MOTEN-ELLIOTT
Credential	:	MS,LMSW,CAADC,CCS-M
Telephone Number	:	989-737-2611

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/15/2015

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