Provider Demographics
NPI:1053610782
Name:ELLEN KEYT, PHD, PLLC
Entity type:Organization
Organization Name:ELLEN KEYT, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KEYT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:313-492-0166
Mailing Address - Street 1:13932 ARNOLD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2817
Mailing Address - Country:US
Mailing Address - Phone:313-492-0166
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:313-492-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty