Healthcare Provider Details

I. General information

NPI: 1821928706
Provider Name (Legal Business Name): TLAZOCAMATI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LIVERNOIS ST STE 214
FERNDALE MI
48220-2675
US

IV. Provider business mailing address

604 W MARSHALL ST
FERNDALE MI
48220-1855
US

V. Phone/Fax

Practice location:
  • Phone: 313-484-0331
  • Fax:
Mailing address:
  • Phone: 313-484-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PROF. CIERRA CHRISTINA VALLES
Title or Position: OWNER/FOUNDER
Credential: LLPC
Phone: 313-484-0331