Provider Demographics
NPI:1578712816
Name:MCGARRAGLE, OLIVIA ALLISON (TLLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ALLISON
Last Name:MCGARRAGLE
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:4TH FLR CARLS BLDG
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-4878
Mailing Address - Fax:313-993-0282
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:4TH FLR CARLS BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-4878
Practice Address - Fax:313-993-0282
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013893103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist