MEDICARE: EVAN HARWOOD TLLP

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
1	103TC0700X	Clinical Psychologist	6362009973	MI

General Provider Information

NPI Number	:	1902636681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN HARWOOD TLLP

Provider Business Mailing Address
First Line	:	4114 WESTOVER DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2867
Country	:	US
Telephone Number	:	248-930-1699
Fax Number	:

Provider Business Practice Location Address
First Line	:	7035 ORCHARD LAKE RD STE 800
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-5301
Country	:	US
Telephone Number	:	248-669-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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Directions to “ EVAN HARWOOD TLLP” Practice Location

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