Provider Demographics
NPI:1659956688
Name:ELZERMAN, JAMES HUBERT (MA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HUBERT
Last Name:ELZERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 MAPLETON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-6394
Mailing Address - Country:US
Mailing Address - Phone:616-481-9791
Mailing Address - Fax:
Practice Address - Street 1:2227 MAPLETON ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6394
Practice Address - Country:US
Practice Address - Phone:616-481-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist