Active NPI
Tanya Marie Petcoff, LLP, MA
- Clinical Psychologist
- Farmington Hills, MI
National Provider Identifier
1265567507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301012794
- Practice address
- 33493 W 14 Mile Rd Ste 130
Farmington Hills, MI 48331-1587 - Phone
- (248) 851-5437
- Fax
- (248) 592-1378
- NPI assigned
- Feb 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301012794 | MI | Primary |
Addresses
Primary practice location
33493 W 14 Mile Rd Ste 130
Farmington Hills, MI 48331-1587
Mailing address
485 Park St
Birmingham, MI 48009-3402
Phone (248) 219-5909
Other practice location 1
441 S Livernois Rd
Suite 205
Rochester Hills, MI 48307-2584
Phone (248) 608-8800 ext. 66
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301012794 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1265567507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "485 PARK ST",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480093402",
"telephone_number": "248-219-5909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33493 W 14 MILE RD STE 130",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483311587",
"telephone_number": "248-851-5437",
"fax_number": "248-592-1378"
}
],
"practiceLocations": [
{
"address_1": "441 S Livernois Rd",
"address_2": "Suite 205",
"address_purpose": "LOCATION",
"city": "Rochester Hills",
"state": "MI",
"postal_code": "483072584",
"country_code": "US",
"telephone_number": "248-608-8800 x66",
"fax_number": "248-608-2490",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETCOFF",
"first_name": "TANYA",
"middle_name": "MARIE",
"credential": "LLP, MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-23",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301012794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.