Provider Demographics
NPI:1740682970
Name:ELZY, BARBARA A
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:ELZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9315 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1260
Mailing Address - Country:US
Mailing Address - Phone:313-450-4500
Mailing Address - Fax:313-450-4513
Practice Address - Street 1:9315 TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:313-450-4500
Practice Address - Fax:313-450-4513
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001020106H00000X
MI6802080373251C00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251C00000XAgenciesDay Training, Developmentally Disabled Services