Provider Demographics
NPI:1821847815
Name:TYLER, MACY V (LLMSW)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:V
Last Name:TYLER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E WHEATON AVE
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-1300
Mailing Address - Country:US
Mailing Address - Phone:989-386-3438
Mailing Address - Fax:
Practice Address - Street 1:205 E WHEATON AVE
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1300
Practice Address - Country:US
Practice Address - Phone:989-386-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511164261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool