Provider Demographics
NPI:1114039856
Name:CENTER FOR EFFECTIVE LIVING INC
Entity Type:Organization
Organization Name:CENTER FOR EFFECTIVE LIVING INC
Other - Org Name:LINDA ROSE CLOR CSW PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LMFT
Authorized Official - Phone:586-228-8838
Mailing Address - Street 1:42657 GARFIELD RD
Mailing Address - Street 2:STE 213
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48044
Mailing Address - Country:US
Mailing Address - Phone:586-228-8838
Mailing Address - Fax:586-228-0813
Practice Address - Street 1:42657 GARFIELD RD
Practice Address - Street 2:STE 213
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-8838
Practice Address - Fax:586-228-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6801035885104100000X
4101005701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008981730OtherBLUE CROSS BLUE SHIELD
MI8008981730OtherBLUE CROSS BLUE SHIELD
=========Medicare UPIN