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1710360573
GRANT MARTIN ELLISON
WAYNE, MI
NPI
1710360573
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: MI 6301016324)
Enumeration Date
2015-06-29
Last Update Date
2015-06-29
Business Address
-- GRANT MARTIN ELLISON
35640 W MICHIGAN AVE
WAYNE, MI 48184-1628
Phone number: 734-729-7792
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Mailing Address
-- GRANT MARTIN ELLISON
4763 GATEWOOD CIR APT 3B
YPSILANTI, MI 48197-5035
Phone number:
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