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General NPI Number Information
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NPI Number | 1003173808
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Entity Type | Individual
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Provider Name | BEVERLY LOUISE TUJAGUE PHD, LLP, CRC, CH
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Gender | Female
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 16200 19 MILE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1103
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Country | US
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Telephone | 248-276-8177
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Fax | 586-416-6129
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Provider Business Mailing Address
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Address Line | 21723 LANGE ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3944
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Country | US
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Telephone | 586-491-9044
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Fax | 586-772-4950
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | L2085895
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License Number State | MI
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