Provider Demographics
NPI:1326206558
Name:TZILOS WERNETTE, GOLFO K (PHD)
Entity Type:Individual
Prefix:
First Name:GOLFO
Middle Name:K
Last Name:TZILOS WERNETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GOLFO
Other - Middle Name:
Other - Last Name:TZILOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:200 ARNET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5753
Practice Address - Country:US
Practice Address - Phone:734-482-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01278103TC0700X
MI6301016359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical