Provider Demographics
NPI:1518425032
Name:ELITE COUNSELING AND SUPERVISION
Entity Type:Organization
Organization Name:ELITE COUNSELING AND SUPERVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:763-360-8494
Mailing Address - Street 1:7194 PARTRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9298
Mailing Address - Country:US
Mailing Address - Phone:763-360-8494
Mailing Address - Fax:
Practice Address - Street 1:7194 PARTRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9298
Practice Address - Country:US
Practice Address - Phone:763-360-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty