=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952154080
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYLOR FABBRI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2024
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 537 CHICAGO AVE
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49048-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-903-0527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1722 123RD AVE
-----------------------------------------------------
City | HOPKINS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49328-9629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-828-8563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------