Provider Demographics
NPI:1194767848
Name:BRAND, ELENA (PHD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36510 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3169
Mailing Address - Country:US
Mailing Address - Phone:248-553-8220
Mailing Address - Fax:248-553-8290
Practice Address - Street 1:36510 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3169
Practice Address - Country:US
Practice Address - Phone:248-553-8220
Practice Address - Fax:248-553-8290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F377870OtherBCBS
MI680F328500OtherBLUE CROSS MICHIGAN
MI680F377870OtherBCBS