Provider Demographics
NPI:1992254460
Name:ELLER, DANIELLE R (MA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:ELLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 STARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1139
Mailing Address - Country:US
Mailing Address - Phone:313-550-8532
Mailing Address - Fax:
Practice Address - Street 1:5597 STARWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-1139
Practice Address - Country:US
Practice Address - Phone:313-550-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst