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NPI Code Detail

MEDICARE: TATYANA AUBREY PRYOR LLMSW

MEDICARE: TATYANA AUBREY PRYOR LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801105087MI

General Provider Information

NPI Number : 1013569920
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATYANA AUBREY PRYOR LLMSW
Provider Business Mailing Address
First Line : 4848 WASHTENAW AVE APT C4
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1487
Country : US
Telephone Number : 661-549-0515
Fax Number :
Provider Business Practice Location Address
First Line : 6821 MEDBURY ST
Second Line :
City : DETROIT
State : MI
Zip : 48211-3317
Country : US
Telephone Number : 313-922-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2019
Last Update Date : 07/10/2019

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