Provider Demographics
NPI:1104604685
Name:ELYSIAN COUNSELING CENTER LLC
Entity type:Organization
Organization Name:ELYSIAN COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-266-0440
Mailing Address - Street 1:465 SE RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2584
Mailing Address - Country:US
Mailing Address - Phone:772-266-0440
Mailing Address - Fax:
Practice Address - Street 1:465 SE RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2584
Practice Address - Country:US
Practice Address - Phone:772-266-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility