Provider Demographics
NPI:1124321070
Name:ELLIAS, GAYLE EDYTH (MSW)
Entity type:Individual
Prefix:MISS
First Name:GAYLE
Middle Name:EDYTH
Last Name:ELLIAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 COOLEY LAKE RD UNIT 59
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-7002
Mailing Address - Country:US
Mailing Address - Phone:248-345-6067
Mailing Address - Fax:
Practice Address - Street 1:7650 COOLEY LAKE RD UNIT 59
Practice Address - Street 2:
Practice Address - City:UNION LAKE
Practice Address - State:MI
Practice Address - Zip Code:48387-7002
Practice Address - Country:US
Practice Address - Phone:248-345-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010638741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical