Healthcare Provider Details

I. General information

NPI: 1922675735
Provider Name (Legal Business Name): TYLER WHITE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 BUTTERFIELD DR
TROY MI
48084-3404
US

IV. Provider business mailing address

2833 BARCLAY WAY
ANN ARBOR MI
48105-9461
US

V. Phone/Fax

Practice location:
  • Phone: 248-831-1057
  • Fax:
Mailing address:
  • Phone: 586-623-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801118212
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: