Provider Demographics
NPI:1528416674
Name:MOORE, TANES R (MA LLP)
Entity Type:Individual
Prefix:MS
First Name:TANES
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1333 BREWERY PARK BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4544
Mailing Address - Country:US
Mailing Address - Phone:313-656-0030
Mailing Address - Fax:248-406-1301
Practice Address - Street 1:1333 BREWERY PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4544
Practice Address - Country:US
Practice Address - Phone:313-656-0030
Practice Address - Fax:248-406-1301
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301003299103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical