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Individual
TYLER LEE BLACKSTOCK
Active
Individual
TYLER LEE BLACKSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC. CADC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6451022333
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B423809497452
DRIVER LICENSE
MI
Enumeration date
10/21/2019
Last updated
03/13/2023
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