Basic Information
| Provider Information | |||||||||
| NPI: | 1073991188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOTTEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JEAN MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. LLP, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 FOREST DR | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490026435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695981178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 277 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | ALLEGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490101138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696735092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2015 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C-00940 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 103TM1800X | 6301010203 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.