MEDICARE: JENNA ELWELL

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	101Y00000X	Counselor	6401225378	MI
2	101YM0800X	Mental Health Counselor	6451023198	MI
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1942956180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ELWELL

Provider Business Mailing Address
First Line	:	9036 KETTERING AVE
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-4254
Country	:	US
Telephone Number	:	248-302-6466
Fax Number	:

Provider Business Practice Location Address
First Line	:	7805 COOLEY LAKE RD STE 200
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3516
Country	:	US
Telephone Number	:	248-302-6466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	12/01/2025

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