Provider Demographics
NPI:1619541174
Name:PEARL, ELISE SARAH (PHD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:SARAH
Last Name:PEARL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:SARAH
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:13660 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1128
Mailing Address - Country:US
Mailing Address - Phone:248-729-1060
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:800-653-6568
Practice Address - Fax:313-916-7263
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019488103T00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical