Provider Demographics
NPI:1073664157
Name:ELLIOTT, STEPHANY ALLYSE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANY
Middle Name:ALLYSE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7011
Mailing Address - Country:US
Mailing Address - Phone:248-787-3963
Mailing Address - Fax:
Practice Address - Street 1:2820 W MAPLE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7011
Practice Address - Country:US
Practice Address - Phone:248-458-2008
Practice Address - Fax:248-458-2015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010876611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical