Provider Demographics
NPI:1629103270
Name:THOMAS, TANYA TERRELL (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:TERRELL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TERRELL CHRISTIAN COUNSELING & BEHAVIORAL HEALTH
Mailing Address - Street 2:17340 W. TWELVE MILE STE 206
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6322
Mailing Address - Country:US
Mailing Address - Phone:248-483-3333
Mailing Address - Fax:248-356-5928
Practice Address - Street 1:17421 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3165
Practice Address - Country:US
Practice Address - Phone:313-531-2500
Practice Address - Fax:313-255-3471
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010611051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical