Provider Demographics
NPI:1790510485
Name:DOLLISON, TYLER (LLPC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:DOLLISON
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27675 SUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3565
Mailing Address - Country:US
Mailing Address - Phone:313-467-9950
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR STE 239
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5206
Practice Address - Country:US
Practice Address - Phone:313-246-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health