Healthcare Provider Details

I. General information

NPI: 1679950067
Provider Name (Legal Business Name): TYLER ARBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17321 TELEGRAPH RD
DETROIT MI
48219-3132
US

IV. Provider business mailing address

32449 PIERCE ST
GARDEN CITY MI
48135-1277
US

V. Phone/Fax

Practice location:
  • Phone: 313-531-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301016696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: