Provider Demographics
NPI:1356010110
Name:ELLIOTT, MARY R (LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OKEMOS ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1226
Mailing Address - Country:US
Mailing Address - Phone:517-833-8100
Mailing Address - Fax:517-676-5460
Practice Address - Street 1:525 OKEMOS ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1226
Practice Address - Country:US
Practice Address - Phone:517-833-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist