Provider Demographics
NPI:1477161347
Name:TIRET, BECKY ANN (MED, EDS)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:TIRET
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6896 PLEASANT RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8677
Mailing Address - Country:US
Mailing Address - Phone:989-529-6767
Mailing Address - Fax:
Practice Address - Street 1:6896 PLEASANT RIDGE TRL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-8677
Practice Address - Country:US
Practice Address - Phone:989-529-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP0000504103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool