Provider Demographics
NPI:1578963716
Name:BISHOP-CHINCHILLA, TANYA ANN (LLMSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:BISHOP-CHINCHILLA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43825 MICHIGAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2551
Mailing Address - Country:US
Mailing Address - Phone:734-397-3088
Mailing Address - Fax:734-397-0078
Practice Address - Street 1:43825 MICHIGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2551
Practice Address - Country:US
Practice Address - Phone:734-397-3088
Practice Address - Fax:734-397-0078
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker