| Doctor Name: | MS. TARA A BALUCK |
| NPI Number: | 1073974978 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., T.L.L.P |
| License Number: | 6301015054 |
| Business Practice Address: | 650 Griswold St Northville, MI - 481671666 |
| Business Phone Number: | 2489120080 |
| Business Fax Number: | |
| Mailing Address: | 650 Griswold St, NORTHVILLE |
| State: | MI |
| Postal Code: | 481671666 |
| Phone Number: | 2489120080 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2016 |
| NPI Last Update Date: | 03/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301015054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |