Provider Demographics
NPI:1144964891
Name:SAVAGE, ROBERT BURNS (TLLP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BURNS
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W ALLEGAN ST FL 7
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-1717
Mailing Address - Country:US
Mailing Address - Phone:313-694-7888
Mailing Address - Fax:
Practice Address - Street 1:20300 SUPERIOR RD STE 250
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6342
Practice Address - Country:US
Practice Address - Phone:313-694-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009516103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling