Provider Demographics
NPI:1760703912
Name:DHALIWAL, TINA KAUR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9653 N GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3513
Mailing Address - Country:US
Mailing Address - Phone:262-404-7166
Mailing Address - Fax:
Practice Address - Street 1:9653 N GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3513
Practice Address - Country:US
Practice Address - Phone:262-404-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WI3033-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor