Basic Information
| Provider Information | |||||||||
| NPI: | 1467577569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGAR | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LLP, TLMFT, CAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAPANIKOLAOU | ||||||||
| OtherFirstName: | TAMARA | ||||||||
| OtherMiddleName: | SH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MA, LLP, TLMFT, CAC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10734 NADINE AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480701520 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 E 11 MILE RD | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480672026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485484044 | ||||||||
| FaxNumber: | 2485489239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TC0700X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Family | 103TP2701X | L973558 | MI | X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 106H00000X | L1041877 | MI | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.