Healthcare Provider Details

I. General information

NPI: 1245572197
Provider Name (Legal Business Name): SUE LAINGE TYCE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29820 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-1844
US

IV. Provider business mailing address

29820 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-1844
US

V. Phone/Fax

Practice location:
  • Phone: 313-303-6604
  • Fax:
Mailing address:
  • Phone: 313-303-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401008067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: