Provider Demographics
NPI:1336652973
Name:ELEMENTS OF WELLNESS LLC
Entity Type:Organization
Organization Name:ELEMENTS OF WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BREANN
Authorized Official - Middle Name:C D
Authorized Official - Last Name:DOTSTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-453-7189
Mailing Address - Street 1:3005 E 11 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3523
Mailing Address - Country:US
Mailing Address - Phone:248-599-1325
Mailing Address - Fax:248-786-6082
Practice Address - Street 1:3005 E 11 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3523
Practice Address - Country:US
Practice Address - Phone:248-599-1325
Practice Address - Fax:248-786-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health