Provider Demographics
NPI:1487865879
Name:TABAR, JENNIFER (BA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TABAR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57519 COPPER CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094
Mailing Address - Country:US
Mailing Address - Phone:586-258-0206
Mailing Address - Fax:586-258-0201
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-258-0206
Practice Address - Fax:586-258-0201
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health