Provider Demographics
NPI:1871813667
Name:KOOLIK, TANIA (PHD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:KOOLIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 GLADES RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4167
Mailing Address - Country:US
Mailing Address - Phone:561-883-5959
Mailing Address - Fax:
Practice Address - Street 1:16244 S MILITARY TRL
Practice Address - Street 2:SUITE 460
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-883-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist