Doctor Name: | TARA MAGER |
NPI Number: | 1205091311 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6401008987 |
Business Practice Address: | 611 N State St Stanton, MI - 488889702 |
Business Phone Number: | 9898317520 |
Business Fax Number: | 9898317578 |
Mailing Address: | 611 N State St, STANTON |
State: | MI |
Postal Code: | 488889702 |
Phone Number: | 9898317520 |
Fax Number: | 9898317578 |
NPI Enumeration Date: | 07/29/2008 |
NPI Last Update Date: | 07/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401008987 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |