Blackstock, Tyler Lee

Blackstock, Tyler Lee is an individual health care provider with primary practice located at 9401 N Haggerty Rd , Plymouth MI 48170-4696. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Blackstock, Tyler Lee can be contacted via phone (734) 845-6010.

Contact Information

Primary practice address
9401 N Haggerty Rd Plymouth MI 48170-4696
Phone: (734) 845-6010
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 6451022333 Michigan

Profile Details

NPI number 1801439112
LBN Legal business name Blackstock, Tyler Lee
Credentials LLPC. CADC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2019
Last updated Mar 13th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801439112 NPPES
Michigan Other B423809497452 DRIVER LICENSE

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