Individual provider · Type 1 NPI

Myranda Ellingsen

Counselor · Southfield, MI

NPI number 1104364124 Active

Practice location

17320 W 12 Mile Rd
Southfield, MI 48076-2100

Call (586) 806-9726 Map

Mailing address

15117 Chatham St
Detroit, MI 48223-1889

Other practice locations

  • 2222 W Grand River Ave Ste A, Okemos, MI 48864-1604 · (586) 806-9726

Specialties and licenses

TaxonomyCodeLicense
Counselor Primary 101Y00000XNone listed

Counselor: A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

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About NPI 1104364124

Myranda Ellingsen's National Provider Identifier is 1104364124, issued on Feb 9, 2017. The primary taxonomy on file is Counselor (101Y00000X), and the practice location is in Southfield, MI. The record was last updated on Aug 20, 2026.