Provider Demographics
NPI:1801383989
Name:TOBIN, ELLEN ANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ANNE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:ANNE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3300 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2810
Mailing Address - Country:US
Mailing Address - Phone:616-942-2110
Mailing Address - Fax:
Practice Address - Street 1:1785 WEST STADIUM BLVD HERON RIDGE ASSOCIATES
Practice Address - Street 2:SUITE #205
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-913-1093
Practice Address - Fax:734-369-2683
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health