Provider Demographics
NPI:1477191559
Name:ELAINE M SWENSON MA LLP PLLC
Entity Type:Organization
Organization Name:ELAINE M SWENSON MA LLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:248-723-6626
Mailing Address - Street 1:31000 LAHSER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4847
Mailing Address - Country:US
Mailing Address - Phone:248-723-6626
Mailing Address - Fax:
Practice Address - Street 1:31000 LAHSER RD STE 8
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4847
Practice Address - Country:US
Practice Address - Phone:248-723-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty