Doctor Name: | MRS. TARA LYNN TREMBLAY |
NPI Number: | 1831596923 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 12124 W Lakeshore Dr Brimley, MI - 497159319 |
Business Phone Number: | 9062488352 |
Business Fax Number: | 9062483508 |
Mailing Address: | 12124 W Lakeshore Dr, BRIMLEY |
State: | MI |
Postal Code: | 497159319 |
Phone Number: | 9062488352 |
Fax Number: | 9062483508 |
NPI Enumeration Date: | 12/04/2014 |
NPI Last Update Date: | 12/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |