Provider Demographics
NPI:1164182911
Name:COMMET, TRICIA (LBSW, CAPS)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:
Last Name:COMMET
Suffix:
Gender:F
Credentials:LBSW, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-0189
Mailing Address - Country:US
Mailing Address - Phone:517-592-1916
Mailing Address - Fax:
Practice Address - Street 1:6546 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8554
Practice Address - Country:US
Practice Address - Phone:517-315-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802068939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker