Healthcare Provider Details

I. General information

NPI: 1588731756
Provider Name (Legal Business Name): TRI CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31800 NORTHWESTERN HWY SUITE 120
FARMINGTON HILLS MI
48334-1663
US

IV. Provider business mailing address

31800 NORTHWESTERN HWY SUITE 120
FARMINGTON HILLS MI
48334-1663
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-8190
  • Fax: 248-702-6704
Mailing address:
  • Phone: 248-559-8190
  • Fax: 248-702-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: PHIA PARHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-559-8190