Individual
GRANT MARTIN ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS LLP
Contact information
Practice address
5340 PLYMOUTH RD STE 202, ANN ARBOR, MI 48105-9341
(734) 462-3210
Mailing address
1055 ALAMO CT, TECUMSEH, MI 49286-9709
(989) 313-0919
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016324
MI
103TC0700X
Clinical Psychologist
Primary
6361005291
MI
Other
Enumeration date
06/29/2015
Last updated
06/24/2026
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