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Tyler Lee Blackstock, LLPCCADC
Professional Counselor in Plymouth, Michigan
NPI 1801439112

Tyler Lee Blackstock is a Professional Counselor based in Cadillac, MI and is specialized in Professional. Tyler Lee Blackstock practices in Plymouth, MI and has the professional credentials of LLPCCADC. The NPI Number for Tyler Lee Blackstock is 1801439112 and holds a License No. 6451022333 (Michigan).

The current practice location address for Tyler Lee Blackstock is 9401 N Haggerty Rd, Plymouth, MI and can be reached out via phone at 734-845-6010.

Location: 9401 N Haggerty Rd, Plymouth, MI, 49601-6044
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801439112
Provider Name
Tyler Lee Blackstock
Credential
LLPCCADC
Provider Entity Type
Individual
Gender
Male
Address
9401 N Haggerty Rd, Plymouth, MI, 49601-6044
Phone Number
734-845-6010
Fax Number
Provider Enumeration Date
10/21/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
B423809497452 01 MI DRIVER LICENSE
institution
Provider Business Practice Location Address Details
Address
9401 N Haggerty Rd
City
Plymouth
State
Michigan
Zip
48170-4696
Phone Number
734-845-6010
Fax Number
person
Provider Business Mailing Address Details
Address
9401 N Haggerty Rd
City
Plymouth
State
Michigan
Zip
48170-4696
Phone Number
734-845-6010
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
6451022333 (Michigan)
Definition
Definition to come...
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