Provider Demographics
NPI:1003173808
Name:TUJAGUE, BEVERLY LOUISE (PHD, LLP, CRC, CH)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:LOUISE
Last Name:TUJAGUE
Suffix:
Gender:F
Credentials:PHD, LLP, CRC, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21723 LANGE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3944
Mailing Address - Country:US
Mailing Address - Phone:586-491-9044
Mailing Address - Fax:586-772-4950
Practice Address - Street 1:16200 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1103
Practice Address - Country:US
Practice Address - Phone:248-276-8177
Practice Address - Fax:586-416-6129
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2085895103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist