Provider Demographics
NPI:1033548458
Name:FRY-RIGGINS, TANGENILLA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:TANGENILLA
Middle Name:
Last Name:FRY-RIGGINS
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E FOREST AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1024
Mailing Address - Country:US
Mailing Address - Phone:313-833-2850
Mailing Address - Fax:313-833-2726
Practice Address - Street 1:1025 E FOREST AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1024
Practice Address - Country:US
Practice Address - Phone:313-833-2850
Practice Address - Fax:313-833-2726
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical