Healthcare Provider Details

I. General information

NPI: 1740667153
Provider Name (Legal Business Name): TONYA MOYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 COLONIAL DR
MONROE MI
48162-2965
US

IV. Provider business mailing address

234 COLONIAL DR
MONROE MI
48162-2965
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-3850
  • Fax: 734-240-3863
Mailing address:
  • Phone: 734-240-3850
  • Fax: 734-240-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401017157
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: