Basic Information
| Provider Information | |||||||||
| NPI: | 1922675735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | TYLER | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57258 YORKSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480943566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866230354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1460 WALTON BLVD STE 120 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483091779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488446234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6851109869 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.