Ellie Mental Health | |
2305 E Paris Ave Se Ste 203 Grand Rapids MI 49546-2426 | |
(616) 816-1758 | |
(616) 333-7685 |
Full Name | Ellie Mental Health |
---|---|
Speciality | Psychologist |
Location | 2305 E Paris Ave Se Ste 203, Grand Rapids, Michigan |
Authorized Official Name and Position | Tory Seif (CLINIC DIRECTOR) |
Authorized Official Contact | 6169166680 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Ellie Mental Health 7150 Armadale Ct Ne Belmont MI 49306-9690 Ph: (586) 764-6671 | Ellie Mental Health 2305 E Paris Ave Se Ste 203 Grand Rapids MI 49546-2426 Ph: (616) 816-1758 |
NPI Number | 1205564531 |
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Provider Enumeration Date | 08/14/2022 |
Last Update Date | 04/26/2024 |
Certification Date | 04/26/2024 |
Medicare PECOS PAC ID | 1557730603 |
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Medicare Enrollment ID | O20221212001673 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205564531 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Provider Name | Tory A Seif |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1841206091 PECOS PAC ID: 6002911187 Enrollment ID: I20100204000386 |
Provider Name | Mary Alice Walker Blanker |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1114335817 PECOS PAC ID: 7416238910 Enrollment ID: I20161221000280 |
Provider Name | Crystal Lee Feyen |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1376979104 PECOS PAC ID: 1254555980 Enrollment ID: I20200511001601 |
Provider Name | Alejandra Vences-jurado |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1780225565 PECOS PAC ID: 3870954761 Enrollment ID: I20230725000771 |
Provider Name | Shasta Lane Gross |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1184143539 PECOS PAC ID: 6305295940 Enrollment ID: I20231208000266 |
Provider Name | Audrey Joy-baker Vander Wal |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1396351995 PECOS PAC ID: 6002256443 Enrollment ID: I20240501003978 |
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