Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | L2085895 | MI |
Y | 103T00000X | Psychologist | L2085895 | MI |
NPI | 1003173808 |
---|---|
Provider Name | Dr. Beverly Louise Tujague |
First Address | Saint Clair Shores, MI 48080-3944 |
Second Address | Clinton Township, MI 48038-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |