Provider Demographics
NPI:1770876476
Name:CLANCY, ELIZABETH ANNE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:37875 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILL
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:248-703-2578
Mailing Address - Fax:
Practice Address - Street 1:37875 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILL
Practice Address - State:MI
Practice Address - Zip Code:48331
Practice Address - Country:US
Practice Address - Phone:248-703-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional