Provider Demographics
NPI:1902109044
Name:TALLY, MAARI ANGELA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MAARI
Middle Name:ANGELA
Last Name:TALLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MAARI
Other - Middle Name:ANGELA
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1843 R.W. BERENDS DR. SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519
Mailing Address - Country:US
Mailing Address - Phone:616-773-2908
Mailing Address - Fax:616-532-3046
Practice Address - Street 1:1843 R W BERENDS DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4955
Practice Address - Country:US
Practice Address - Phone:616-773-2908
Practice Address - Fax:616-532-3046
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015037103TC0700X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)