Provider Demographics
NPI:1861854879
Name:ELYSIAN
Entity type:Organization
Organization Name:ELYSIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:ALYN
Authorized Official - Last Name:HATZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:765-617-6043
Mailing Address - Street 1:2082 N BILBREY LN
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-8756
Mailing Address - Country:US
Mailing Address - Phone:765-617-6043
Mailing Address - Fax:
Practice Address - Street 1:2082 N BILBREY LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-8756
Practice Address - Country:US
Practice Address - Phone:765-617-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty