Provider Demographics
NPI:1790302255
Name:DONAJKOWSKI, TELLIS COLT (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:TELLIS
Middle Name:COLT
Last Name:DONAJKOWSKI
Suffix:
Gender:M
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20240 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-957-8973
Mailing Address - Fax:888-390-4330
Practice Address - Street 1:20240 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-957-8973
Practice Address - Fax:888-390-4330
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009882103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling