Provider Demographics
NPI:1043921232
Name:ELLUL, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ELLUL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 WHITCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2011
Mailing Address - Country:US
Mailing Address - Phone:231-735-4585
Mailing Address - Fax:
Practice Address - Street 1:117 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3831
Practice Address - Country:US
Practice Address - Phone:249-965-6605
Practice Address - Fax:313-335-3136
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health