Healthcare Provider Details

I. General information

NPI: 1265862148
Provider Name (Legal Business Name): TARSHA GALE M.A., TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 AXTELL DR 100
TROY MI
48084-4404
US

IV. Provider business mailing address

8223 SAN MARCO BLVD
STERLING HEIGHTS MI
48313-4764
US

V. Phone/Fax

Practice location:
  • Phone: 313-402-0934
  • Fax:
Mailing address:
  • Phone: 313-402-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301016189
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: