Basic Information
| Provider Information | |||||||||
| NPI: | 1295043818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALBOT | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | GRAZIOLI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C., L.M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 888 W. BIG BEAVER RD. | ||||||||
| Address2: | 1450 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482448644 | ||||||||
| FaxNumber: | 2482441330 | ||||||||
| Practice Location | |||||||||
| Address1: | 888 W BIG BEAVER RD | ||||||||
| Address2: | 1450 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480844736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482448644 | ||||||||
| FaxNumber: | 2482441330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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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 | 101YM0800X | L1778658 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | L1356631 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.