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General NPI Number Information
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NPI Number | 1134904972
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Entity Type | Individual
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Provider Name | TANDY JURGENSEN LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 628 E PARENT AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3765
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Country | US
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Telephone | 248-221-2734
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Fax |
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Provider Business Mailing Address
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Address Line | 10535 VERNON AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1565
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Country | US
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Telephone | 248-979-1219
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401015001
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101007646
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License Number State | MI
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