Provider Demographics
NPI:1932744604
Name:JEFFREY, ELEANOR GRACE (TLLP)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:GRACE
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36783 SUNNYDALE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1718
Mailing Address - Country:US
Mailing Address - Phone:248-461-7941
Mailing Address - Fax:
Practice Address - Street 1:323 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2322
Practice Address - Country:US
Practice Address - Phone:989-510-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical