| Tara Blury Llc | |
|
1838 Portadown Sw Byron Center MI 49315-8081 | |
| (248) 930-5620 | |
| Not Available |
| Full Name | Tara Blury Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1838 Portadown Sw, Byron Center, Michigan |
| Authorized Official Name and Position | Tara Blury (OWNER) |
| Authorized Official Contact | 2489305620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Blury Llc Po Box 10 Mason MI 48854-0010 Ph: (517) 676-9788 | Tara Blury Llc 1838 Portadown Sw Byron Center MI 49315-8081 Ph: (248) 930-5620 |
| NPI Number | 1619378767 |
|---|---|
| Provider Enumeration Date | 09/09/2014 |
| Last Update Date | 09/09/2014 |
| Medicare PECOS PAC ID | 1951623495 |
|---|---|
| Medicare Enrollment ID | O20141211001055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619378767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801091145 (Michigan) | Primary |
| Provider Name | Tara M Blury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467687913 PECOS PAC ID: 2769704204 Enrollment ID: I20141211001127 |
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