Provider Demographics
NPI:1730265364
Name:BYRUM, ELMER WAYNE (LMSW)
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:WAYNE
Last Name:BYRUM
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 1:1591 PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6623
Mailing Address - Country:US
Mailing Address - Phone:734-776-5222
Mailing Address - Fax:
Practice Address - Street 1:3800 PACKARD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2073
Practice Address - Country:US
Practice Address - Phone:734-973-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010831031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical