Provider Demographics
NPI:1205690542
Name:BAGDASARIAN, TALAR (MA TLLP)
Entity type:Individual
Prefix:
First Name:TALAR
Middle Name:
Last Name:BAGDASARIAN
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28991 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2323
Mailing Address - Country:US
Mailing Address - Phone:248-921-7983
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST STE 2300G
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1889
Practice Address - Country:US
Practice Address - Phone:734-323-4897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009883103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling