Provider Demographics
| NPI: | 1568824472 |
|---|---|
| Name: | THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC |
| Entity Type: | Organization |
| Organization Name: | THE ELYSIAN FIELDS OPTIMUM WELLNESS AND MENTAL HEALTH GROUP, LLC |
| Other - Org Name: | THE SEVENTY TIMES SEVEN WELLNESS MISSION |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRINCIPAL |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ARTHUR |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | GRIFFIN |
| Authorized Official - Suffix: | JR |
| Authorized Official - Credentials: | MISE, MBA |
| Authorized Official - Phone: | 913-226-9499 |
| Mailing Address - Street 1: | 2222 N HOWARD ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BALTIMORE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21218-5609 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 410-624-5037 |
| Mailing Address - Fax: | 800-405-6914 |
| Practice Address - Street 1: | 2222 N HOWARD ST |
| Practice Address - Street 2: | |
| Practice Address - City: | BALTIMORE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21218-5609 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 410-624-5037 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-03-22 |
| Last Update Date: | 2023-03-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral | Group - Multi-Specialty |
| No | 102L00000X | Behavioral Health & Social Service Providers | Psychoanalyst | Group - Multi-Specialty | |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | Group - Multi-Specialty |
| No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
