Provider Demographics
NPI:1730466632
Name:TOBEY, JACQUELYN JUANITA (LLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:JUANITA
Last Name:TOBEY
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50256 JACKSON LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3436
Mailing Address - Country:US
Mailing Address - Phone:734-968-6480
Mailing Address - Fax:
Practice Address - Street 1:650 CHURCH ST RM 313
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1689
Practice Address - Country:US
Practice Address - Phone:734-215-7202
Practice Address - Fax:856-997-1717
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist