Most Relevant Information
Provider Data
| NPI Number: | 1003465816 |
| Provider Name: | ELYSSA TAYLOR SMITH |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/05/2019 |
| Last Updated: | 06/13/2022 |
Provider Practice Location
175 N GROESBECK HWY
MOUNT CLEMENS
MI
480431562
Practice Location Phone/Fax
| Phone: | 5867135103 |
| Fax: |
Provider Mailing Location
175 N GROESBECK HWY
MOUNT CLEMENS
MI
480431562
Provider Mailing Phone/Fax
| Phone: | 6163018000 |
| Fax: |