Provider Demographics
NPI:1861898108
Name:ELLIOTT, LEAH JANE (LMSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JANE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JANE
Other - Last Name:TIBBETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4925 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1521
Mailing Address - Country:US
Mailing Address - Phone:734-926-4650
Mailing Address - Fax:734-971-2730
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-926-4650
Practice Address - Fax:734-971-2730
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010907861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical