Healthcare Provider Details

I. General information

NPI: 1962367490
Provider Name (Legal Business Name): TANYA M GILLAN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SEWARD ST APT 307
DETROIT MI
48202-4447
US

IV. Provider business mailing address

120 SEWARD ST APT 307
DETROIT MI
48202-4447
US

V. Phone/Fax

Practice location:
  • Phone: 808-218-0319
  • Fax:
Mailing address:
  • Phone: 808-218-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4704319830
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4704319830
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4704319830
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4704319830
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: