Provider Demographics
NPI:1922776285
Name:POWERS, TANAQUIL (LIFESTYLE COACH)
Entity Type:Individual
Prefix:
First Name:TANAQUIL
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LIFESTYLE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W 9 MILE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1750
Mailing Address - Country:US
Mailing Address - Phone:313-879-9301
Mailing Address - Fax:855-516-8881
Practice Address - Street 1:195 W 9 MILE RD STE 207
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1750
Practice Address - Country:US
Practice Address - Phone:313-879-9301
Practice Address - Fax:855-516-8881
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty