Healthcare Provider Details

I. General information

NPI: 1922575570
Provider Name (Legal Business Name): DARRYL TONEMAH PHD,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SUPERIOR AVE
BARAGA MI
49908-9673
US

IV. Provider business mailing address

3271 PALMER RD
RANSOMVILLE NY
14131-9686
US

V. Phone/Fax

Practice location:
  • Phone: 906-353-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301017752
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1314
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: