Elise Ashley Goulbourne, LLPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6451022680 Issued in MI

Practice address

2995 E Grand Blvd
Detroit, MI 48202-3133

Phone

(313) 758-0150

Fax

(313) 758-0255

NPI assigned

Jan 24, 2014

Last updated

Aug 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Black Family Development, Inc.

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1821120445

  Counseling

  NPD (past)
• Dashawn Wallace Counseling, LLC

  • Professional Counselor
  • Ypsilanti, MI
  • NPI 1518586411
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1376966572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2995 E GRAND BLVD STE 1038",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023133",
            "telephone_number": "313-758-0150",
            "fax_number": "313-758-0255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2995 E GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023133",
            "telephone_number": "313-758-0150",
            "fax_number": "313-758-0255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481972617",
            "country_code": "US",
            "telephone_number": "734-999-0138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOULBOURNE",
        "first_name": "ELISE",
        "middle_name": "ASHLEY",
        "name_prefix": "Miss",
        "credential": "LLPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-24",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6451022680",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301015813",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Richard Gottschalk, PAC
• Amy Charleen Goudy
• Christine Miriam Gougeon
• Mercedes Gough
• Tremon Gougisha Jr.
• Bianca Gould
• Jonathon F Gould, MD
• Wendy M Gould, M.D.
• Shiwanda Govan, MD
• Michael Jason Govier

• Professional Counselor in Detroit, MI
• Providers in Detroit, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.