MEDICARE: SUE LAINGE TYCE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401008067	MI

General Provider Information

NPI Number	:	1245572197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE LAINGE TYCE PHD

Provider Business Mailing Address
First Line	:	29820 JEFFERSON AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-1844
Country	:	US
Telephone Number	:	313-303-6604
Fax Number	:

Provider Business Practice Location Address
First Line	:	29820 JEFFERSON AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-1844
Country	:	US
Telephone Number	:	313-303-6604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	06/11/2026

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