Provider Demographics
NPI:1104064393
Name:DENARD, TENIA L (BA)
Entity type:Individual
Prefix:
First Name:TENIA
Middle Name:L
Last Name:DENARD
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 1:25 S MONROE ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2468
Mailing Address - Country:US
Mailing Address - Phone:734-240-3084
Mailing Address - Fax:
Practice Address - Street 1:25 S MONROE ST
Practice Address - Street 2:STE. 103
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2468
Practice Address - Country:US
Practice Address - Phone:734-240-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801084613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-0-89-8408-0OtherBLUE CROSS BLUE SHIELD, BLUE CARE NETWORK OF MICHIGAN