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NPI Code Detail

MEDICARE: TLAZOCAMATI LLC

MEDICARE: TLAZOCAMATI LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1821928706
Entity Type Code : Organization
Provider Name (Legal Business Name) : TLAZOCAMATI LLC
Provider Business Mailing Address
First Line : 604 W MARSHALL ST
Second Line :
City : FERNDALE
State : MI
Zip : 48220-1855
Country : US
Telephone Number : 313-484-0331
Fax Number :
Provider Business Practice Location Address
First Line : 429 LIVERNOIS ST STE 214
Second Line :
City : FERNDALE
State : MI
Zip : 48220-2675
Country : US
Telephone Number : 313-484-0331
Fax Number :
Authorized Official
Title or Position : OWNER/FOUNDER
Name : PROF. CIERRA CHRISTINA VALLES
Credential : LLPC
Telephone Number : 313-484-0331
Provider Enumeration Date : 05/21/2026
Last Update Date : 05/21/2026

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Directions to “TLAZOCAMATI LLC ” Practice Location

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