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SHIRAZ TATA PHD LLC NPI 1083109524


NPI Information

NPI: 1083109524
Provider Name: SHIRAZ TATA PHD LLC

Former Legal Business Name: SHIRAZ P. TATA

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
6072 BRYNWOOD DR STE 107
ROCKFORD, IL
ZIP 61114
Phone: (815) 519-2949
Get Directions

SHIRAZ TATA PHD LLC is a clinical psychologist in Rockford, IL. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. SHIRAZ TATA PHD LLC NPI is 1083109524. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Shiraz P. Tata.

The provider's business location address is:

6072 BRYNWOOD DR STE 107
ROCKFORD, IL
ZIP 61114
Phone: (815) 519-2949

The provider's authorized official is Shiraz P Tata .
The authorized official title is Licensed Clinical Psychologist and has the following contact phone number (815) 519-2949.

The enumeration date for this NPI number is 6/27/2018 and was last updated on 8/1/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TC0700XPsychologistClinical071.04963ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
111740000OTHERCAQH
2819809569OTHERBCBSIL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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