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Shiraz Tata Phd Llc
Clinical Psychologist in Rockford, Illinois
NPI 1083109524

Shiraz Tata Phd Llc is a Clinical Psychologist based in Rockford, IL and is specialized in Clinical. Shiraz Tata Phd Llc practices in Rockford, IL. The NPI Number for Shiraz Tata Phd Llc is 1083109524 and holds a License No. 071.04963 (Illinois).

The current practice location address for Shiraz Tata Phd Llc is 6072 Brynwood Dr Ste 107, Rockford, IL and can be reached out via phone at 815-519-2949.

Location: 6072 Brynwood Dr Ste 107, Rockford, IL, 61114-5829
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1083109524
Provider Name
Shiraz Tata Phd Llc
Credential
Provider Entity Type
Organization
Address
6072 Brynwood Dr Ste 107, Rockford, IL, 61114-5829
Phone Number
815-519-2949
Fax Number
Provider Enumeration Date
06/27/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
819809569 01 BCBSIL
11740000 01 CAQH
institution
Provider Business Practice Location Address Details
Address
6072 Brynwood Dr Ste 107
City
Rockford
State
Illinois
Zip
61114
Phone Number
815-519-2949
Fax Number
person
Provider Business Mailing Address Details
Address
6072 Brynwood Dr Ste 107
City
Rockford
State
Illinois
Zip
61114
Phone Number
815-519-2949
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Clinical
Taxonomy
103TC0700X
License No.
071.04963 (Illinois)
Definition
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.
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