Provider Demographics
NPI:1477026649
Name:MCELYEA, PATRICK WILLIAM (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WILLIAM
Last Name:MCELYEA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1641
Mailing Address - Country:US
Mailing Address - Phone:810-623-0038
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1777
Practice Address - Country:US
Practice Address - Phone:248-981-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801874251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10162000OtherBLUE CROSS BLUE SHIELD