Provider Demographics
NPI:1083101729
Name:TYREE, JEANNINE ALISE (MRC, CRC, LLPC)
Entity Type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:ALISE
Last Name:TYREE
Suffix:
Gender:F
Credentials:MRC, CRC, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CHICAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1421
Mailing Address - Country:US
Mailing Address - Phone:313-867-1115
Mailing Address - Fax:
Practice Address - Street 1:28303 JOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-5524
Practice Address - Country:US
Practice Address - Phone:734-513-1122
Practice Address - Fax:734-421-1405
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor