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NPI Code Detail

MEDICARE: MISS TARA S TYUS FSAC

MEDICARE: MISS TARA S TYUS FSAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1144346131
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TARA S TYUS FSAC
Provider Business Mailing Address
First Line : 11476 BALFOUR RD
Second Line :
City : DETROIT
State : MI
Zip : 48224-1188
Country : US
Telephone Number : 313-822-6940
Fax Number : 313-822-6946
Provider Business Practice Location Address
First Line : 13340 E WARREN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48215-2112
Country : US
Telephone Number : 313-822-6940
Fax Number : 313-822-6946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

Similar Medicare Providers

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Practice Location Address:
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DETROIT, MI
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1801913827 — CHARLOTTE JARRETT FAODP
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1548387558 — LYDIA LENICE KNIGHT SOCIAL WORKER TECH
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Directions to “ MISS TARA S TYUS FSAC” Practice Location

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