Provider Demographics
NPI:1710067103
Name:TOTAL COMPREHENSIVE BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:TOTAL COMPREHENSIVE BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/THERAPUETIC COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TUCKER-LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LPC
Authorized Official - Phone:313-268-3070
Mailing Address - Street 1:8031 TIREMAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3469
Mailing Address - Country:US
Mailing Address - Phone:313-268-3070
Mailing Address - Fax:313-526-5747
Practice Address - Street 1:8031 TIREMAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3469
Practice Address - Country:US
Practice Address - Phone:313-268-3070
Practice Address - Fax:313-526-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007866101Y00000X
MI6401004803101Y00000X
MI68010653141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty