MEDICARE: LYNNE G TENBUSCH, PH D PC

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
1	103T00000X	Psychologist	6301003134	MI

General Provider Information

NPI Number	:	1467500678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNNE G TENBUSCH, PH D PC

Provider Business Mailing Address
First Line	:	2301 S HURON PKWY
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-973-3232
Fax Number	:	734-428-8659

Provider Business Practice Location Address
First Line	:	2301 S HURON PKWY
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-5133
Country	:	US
Telephone Number	:	734-973-3232
Fax Number	:	734-428-8659

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNNE GERTRUDE TENBUSCH
Credential	:	PH.D.
Telephone Number	:	734-973-3232

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	08/22/2020

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