Colleen Marie Tavor, MA, LPC, NCC, CCTP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401010162 Issued in MI

Practice address

17344 W 12 Mile Rd
Suite 203
Southfield, MI 48076-2121

Phone

(248) 302-9396

NPI assigned

May 12, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1235540337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32718 GRAND RIVER AVE UNIT C5",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363155",
            "telephone_number": "248-302-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17344 W 12 MILE RD",
            "address_2": "SUITE 203",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762121",
            "telephone_number": "248-302-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVOR",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "credential": "MA, LPC, NCC, CCTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-12",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401010162",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401010162",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010162",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Southfield, MI
• Providers in Southfield, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.