Provider Demographics
NPI:1689054736
Name:BUGG, TARA (LMSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BUGG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42590 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9732
Mailing Address - Country:US
Mailing Address - Phone:269-303-0296
Mailing Address - Fax:
Practice Address - Street 1:801 HAZEN ST
Practice Address - Street 2:SUITE C
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079
Practice Address - Country:US
Practice Address - Phone:269-655-3367
Practice Address - Fax:269-657-3474
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010980101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical