Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | L973558 | MI |
N | 103T00000X | Psychologist | L973558 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | L973558 | MI |
N | 103G00000X | Clinical Psychologist | L973558 | MI |
N | 103TC0700X | Clinical Psychologist | L973558 | MI |
N | 103TC1900X | Counseling Psychologist | L973558 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | L973558 | MI |
N | 103TF0000X | Family Psychologist | L973558 | MI |
N | 103TP2701X | Group Psychotherapist | L973558 | MI |
NPI | 1467577569 |
---|---|
Provider Name | Tamara S Hagar |
First Address | Huntington Woods, MI 48070-1520 |
Second Address | Royal Oak, MI 48067-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |