Healthcare Provider Details

I. General information

NPI: 1760029854
Provider Name (Legal Business Name): TYLER DOUGLAS HOBBS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 CONGRESS AVE
SAGINAW MI
48602-3106
US

IV. Provider business mailing address

3253 CONGRESS AVE
SAGINAW MI
48602-3106
US

V. Phone/Fax

Practice location:
  • Phone: 989-475-4171
  • Fax: 989-393-6021
Mailing address:
  • Phone: 989-475-4171
  • Fax: 989-393-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851106067
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: