Provider Demographics
NPI:1326616384
Name:ELYSIAN PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:ELYSIAN PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:989-464-4252
Mailing Address - Street 1:4250 FAIRFAX DR
Mailing Address - Street 2:SUITE 600 #0911
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1665
Mailing Address - Country:US
Mailing Address - Phone:757-720-7265
Mailing Address - Fax:
Practice Address - Street 1:4250 FARIFAX DR
Practice Address - Street 2:SUITE 600 #0911
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1665
Practice Address - Country:US
Practice Address - Phone:757-720-7265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)