Provider Demographics
NPI:1720654163
Name:ELLIAS, ALAN ALEXANDER (LMSW)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ALEXANDER
Last Name:ELLIAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24105 LORI CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2835
Mailing Address - Country:US
Mailing Address - Phone:248-520-8766
Mailing Address - Fax:248-888-9794
Practice Address - Street 1:24105 LORI CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2835
Practice Address - Country:US
Practice Address - Phone:248-520-8766
Practice Address - Fax:248-888-9794
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010696511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical