Provider Demographics
NPI:1336799972
Name:ELEMENT PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:ELEMENT PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TYSAR-GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-229-4778
Mailing Address - Street 1:27941 HARPER AVENUE, STE 103 MAILBOX#5
Mailing Address - Street 2:
Mailing Address - City:ST. CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1535
Mailing Address - Country:US
Mailing Address - Phone:249-229-4778
Mailing Address - Fax:
Practice Address - Street 1:27941 HARPER AVENUE, STE 103 MAILBOX#5
Practice Address - Street 2:
Practice Address - City:ST. CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1535
Practice Address - Country:US
Practice Address - Phone:249-229-4778
Practice Address - Fax:586-859-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty