Provider Demographics
NPI:1750779401
Name:AHLIJIAN, MEAGAN (TLLP)
Entity type:Individual
Prefix:MRS
First Name:MEAGAN
Middle Name:
Last Name:AHLIJIAN
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21120 WHITLOCK ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5176
Mailing Address - Country:US
Mailing Address - Phone:734-891-5749
Mailing Address - Fax:
Practice Address - Street 1:23985 NOVI RD
Practice Address - Street 2:SUITE B104
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5436
Practice Address - Country:US
Practice Address - Phone:734-891-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical