Provider Demographics
NPI:1336655216
Name:MARISCAL-TORRES, ELLEN B
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:B
Last Name:MARISCAL-TORRES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:B
Other - Last Name:CAPOBRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32229 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4302
Mailing Address - Country:US
Mailing Address - Phone:734-261-4192
Mailing Address - Fax:
Practice Address - Street 1:32229 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4302
Practice Address - Country:US
Practice Address - Phone:734-261-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health