Provider Demographics
NPI:1356595631
Name:TOBIN, ILONA L (EDD)
Entity type:Individual
Prefix:DR
First Name:ILONA
Middle Name:L
Last Name:TOBIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S ADAMS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7016
Mailing Address - Country:US
Mailing Address - Phone:248-792-9298
Mailing Address - Fax:248-792-9298
Practice Address - Street 1:801 S ADAMS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7016
Practice Address - Country:US
Practice Address - Phone:248-792-9298
Practice Address - Fax:248-792-9298
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005206106H00000X
MI6301003839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1369Medicare PIN