Basic Information
Provider Information
NPI: 1326252610
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOPPE ROONEY
FirstName: TIANNA
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 TORREY RD STE 100
Address2:  
City: FENTON
State: MI
PostalCode: 484303327
CountryCode: US
TelephoneNumber: 8104947180
FaxNumber: 2176924936
Practice Location
Address1: 1100 TORREY RD STE 100
Address2:  
City: FENTON
State: MI
PostalCode: 484303327
CountryCode: US
TelephoneNumber: 8104947180
FaxNumber: 2486924936
Other Information
ProviderEnumerationDate: 05/09/2007
LastUpdateDate: 08/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X4101006287MIY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

ID Information
IDTypeStateIssuerDescription
101194701MIMCLAREN HEALTH ADVANTAGEOTHER


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