Provider Demographics
NPI:1043780976
Name:DEBORAH MCTYRE MSW LMSW LLC
Entity Type:Organization
Organization Name:DEBORAH MCTYRE MSW LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-515-1863
Mailing Address - Street 1:21925 SUSSEX ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3511
Mailing Address - Country:US
Mailing Address - Phone:313-515-1863
Mailing Address - Fax:
Practice Address - Street 1:21925 SUSSEX ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3511
Practice Address - Country:US
Practice Address - Phone:313-515-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty