Provider Demographics
NPI:1508284332
Name:ELDER, NUZMEYA (PHD)
Entity Type:Individual
Prefix:
First Name:NUZMEYA
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32480 WING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1928
Mailing Address - Country:US
Mailing Address - Phone:313-842-0554
Mailing Address - Fax:
Practice Address - Street 1:32480 WING LAKE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1928
Practice Address - Country:US
Practice Address - Phone:313-842-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health