Provider Demographics
NPI:1447598545
Name:BRISSETTE, ELON MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ELON
Middle Name:MARIE
Last Name:BRISSETTE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:3720 WILDER RD
Practice Address - Street 2:UNIT B
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2482
Practice Address - Country:US
Practice Address - Phone:989-460-1000
Practice Address - Fax:989-460-1003
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional