Provider Demographics
NPI:1396531125
Name:ELYSIAN THERAPEUTICS LLC
Entity type:Organization
Organization Name:ELYSIAN THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORMENOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-638-2819
Mailing Address - Street 1:1801 FAYETTEVILLE STREET
Mailing Address - Street 2:STE 19855C
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-638-2819
Mailing Address - Fax:
Practice Address - Street 1:1801 FAYETTEVILLE STREET
Practice Address - Street 2:STE 19855C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-638-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty