Provider Demographics
NPI:1588370845
Name:ELYSIAN COUNSELING
Entity type:Organization
Organization Name:ELYSIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-CLINICAL
Authorized Official - Phone:734-548-3606
Mailing Address - Street 1:12663 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9670
Mailing Address - Country:US
Mailing Address - Phone:734-548-3606
Mailing Address - Fax:
Practice Address - Street 1:325 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2697
Practice Address - Country:US
Practice Address - Phone:734-418-8080
Practice Address - Fax:734-519-6324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty