Provider Demographics
NPI:1104998731
Name:SHERMAN, TANYA ERGH (PHD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ERGH
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:CHRISTINE
Other - Last Name:ERGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 641245
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48264-1245
Mailing Address - Country:US
Mailing Address - Phone:313-966-2390
Mailing Address - Fax:
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2417
Practice Address - Country:US
Practice Address - Phone:313-966-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301012705OtherLICENSE