Provider Demographics
NPI:1558698860
Name:ELMOURSI, RANYA (MA, TLLP)
Entity Type:Individual
Prefix:MRS
First Name:RANYA
Middle Name:
Last Name:ELMOURSI
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16921 W. WARREN ROAD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228
Mailing Address - Country:US
Mailing Address - Phone:313-581-7287
Mailing Address - Fax:
Practice Address - Street 1:16921 W. WARREN ROAD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228
Practice Address - Country:US
Practice Address - Phone:313-581-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid