Provider Demographics
NPI:1184132961
Name:PAVLICEK, ELEKTRA (LPC)
Entity type:Individual
Prefix:MS
First Name:ELEKTRA
Middle Name:
Last Name:PAVLICEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:WSUPG PSYCHIATRY CREDENTIALING - SUITE 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1135
Mailing Address - Country:US
Mailing Address - Phone:248-581-5973
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:3901 CHRYSLER DRIVE
Practice Address - Street 2:TOLAN PARK
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2167
Practice Address - Country:US
Practice Address - Phone:313-993-3964
Practice Address - Fax:313-993-1372
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401014720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional