Provider Demographics
NPI:1104222728
Name:ELM ENTERPRISES, LLC
Entity Type:Organization
Organization Name:ELM ENTERPRISES, LLC
Other - Org Name:BE PRESENT AND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:9906-233-7477
Mailing Address - Street 1:1100 LUDINGTON ST
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3542
Mailing Address - Country:US
Mailing Address - Phone:906-233-7477
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:SUITE 301A
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-233-7477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010870721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11753205OtherCAQH