Provider Demographics
NPI:1922575570
Name:TONEMAH, DARRYL (PHD,)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:
Last Name:TONEMAH
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-9686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9673
Practice Address - Country:US
Practice Address - Phone:906-353-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017752103TC1900X
OK1314103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty