Provider Demographics
NPI:1750852570
Name:TYLER POLLACK INCORPORATED
Entity Type:Organization
Organization Name:TYLER POLLACK INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-546-3833
Mailing Address - Street 1:49791 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3425
Mailing Address - Country:US
Mailing Address - Phone:734-546-3833
Mailing Address - Fax:
Practice Address - Street 1:595 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1775
Practice Address - Country:US
Practice Address - Phone:734-546-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)