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General NPI Number Information
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NPI Number | 1235540337
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Entity Type | Individual
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Provider Name | COLLEEN MARIE TAVOR MA, LPC, NCC, CCTP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 17344 W 12 MILE RD SUITE 203
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2121
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Country | US
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Telephone | 248-302-9396
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Fax |
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Provider Business Mailing Address
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Address Line | 32718 GRAND RIVER AVE UNIT C5
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City | FARMINGTON
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State | MI
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Zip | 48336-3155
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Country | US
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Telephone | 248-302-9396
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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 | 6401010162
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401010162
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401010162
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License Number State | MI
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