Provider Demographics
NPI:1649661869
Name:LIETO, ELISHA
Entity type:Individual
Prefix:MRS
First Name:ELISHA
Middle Name:
Last Name:LIETO
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 1:621 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1440
Mailing Address - Country:US
Mailing Address - Phone:734-265-0334
Mailing Address - Fax:734-384-3030
Practice Address - Street 1:621 MONROE STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1440
Practice Address - Country:US
Practice Address - Phone:734-265-0334
Practice Address - Fax:734-384-3030
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)