NPIMap

Organization Active NPI

Ellie Mental Health Live Authentic PLLC

  • Counseling Psychologist
  • Novi, MI
National Provider Identifier
1760193031
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
ELLIE MENTAL HEALTH LIVE AUTHENTIC PLLC
Practice address
41800 W 11 Mile Rd Ste 110
Novi, MI 48375-1818
Phone
(947) 219-1283
NPI assigned
Dec 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Authorized official

Name
Jeff McDonald
Title
Operations Manger
Phone
(810) 302-4777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X Primary

Addresses

Primary practice location

41800 W 11 Mile Rd Ste 110
Novi, MI 48375-1818

Mailing address

41800 W 11 Mile Rd Ste 110
Novi, MI 48375-1818
Phone (947) 219-1283

Other practice location 1

6960 Orchard Lake Rd Ste 202
West Bloomfield, MI 48322
Phone (248) 985-9942

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230314002233 MI Part B Supplier - Clinic/Group Practice 0648644658 Receives reassigned benefits from 12 practitioners
Practice locations: Novi, MI; West Bloomfield, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752192000000",
    "number": "1760193031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41800 W 11 MILE RD STE 110",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751818",
            "telephone_number": "947-219-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41800 W 11 MILE RD STE 110",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751818",
            "telephone_number": "947-219-1283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6960 Orchard Lake Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "West Bloomfield",
            "state": "MI",
            "postal_code": "48322",
            "country_code": "US",
            "telephone_number": "248-985-9942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELLIE MENTAL HEALTH LIVE AUTHENTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-07",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "OPERATIONS MANGER",
        "authorized_official_telephone_number": "810-302-4777"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Novi, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.