Provider Demographics
NPI:1073991188
Name:TOTTEN, ELIZABETH JEAN MARIE (MA LLP, CAADC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEAN MARIE
Last Name:TOTTEN
Suffix:
Gender:F
Credentials:MA LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-6435
Mailing Address - Country:US
Mailing Address - Phone:269-598-1178
Mailing Address - Fax:
Practice Address - Street 1:277 NORTH ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1138
Practice Address - Country:US
Practice Address - Phone:269-673-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00940101YA0400X
MI6301010203103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)