Provider Demographics
NPI:1710105887
Name:ELLEN STONE PC
Entity Type:Organization
Organization Name:ELLEN STONE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELLENSTONE PC
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:248-661-2498
Mailing Address - Street 1:5236 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1549
Mailing Address - Country:US
Mailing Address - Phone:248-661-2498
Mailing Address - Fax:
Practice Address - Street 1:5236 PATRICK RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1549
Practice Address - Country:US
Practice Address - Phone:248-661-2498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty