Tyler Lee Blackstock, LLPC CADC in Plymouth, MI

Tyler Lee Blackstock, LLPC CADC is a medicare enrolled "Counselor - Professional" provider in Plymouth, Michigan. His current practice location is 9401 N Haggerty Rd, Plymouth, Michigan. You can reach out to his office (for appointments etc.) via phone at (734) 845-6010.

Tyler Lee Blackstock is licensed to practice in Michigan (license number 6451022333) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1801439112.

Contact Information

	Tyler Lee Blackstock, LLPC CADC
	9401 N Haggerty Rd, Plymouth, MI 48170-4696
	(734) 845-6010
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Tyler Lee Blackstock
Gender	Male
Speciality	Counselor - Professional
Location	9401 N Haggerty Rd, Plymouth, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1801439112
Provider Enumeration Date: 10/21/2019
Last Update Date: 03/13/2023

Medicare PECOS Information:

PECOS PAC ID: 8426582446
Enrollment ID: I20241113004488

Medical Identifiers

Medical identifiers for Tyler Lee Blackstock such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1801439112	NPI	-	NPPES
B423809497452	Other	MI	DRIVER LICENSE

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YP2500X	Counselor - Professional	6451022333 (Michigan)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tyler Lee Blackstock allows following entities to bill medicare on his behalf.

Entity Name	Michigan Safe Space Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1407571581 PECOS PAC ID: 0446627491 Enrollment ID: O20221103000495

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tyler Lee Blackstock is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Tyler Lee Blackstock, LLPC CADC Po Box 1044, Cadillac, MI 49601-6044 Ph: () -	Tyler Lee Blackstock, LLPC CADC 9401 N Haggerty Rd, Plymouth, MI 48170-4696 Ph: (734) 845-6010

Reviews and Comments

Counselor in Plymouth, MI

George Bruce Minor, Counselor Medicare: Not Enrolled in Medicare Practice Location: 271 S Main St, Plymouth, MI 48170 Phone: 734-495-4055
Jennifer Theresa Burke, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 575 S Main St, Plymouth, MI 48170 Phone: 248-213-7276 Fax: 313-274-7933
Jamie Artman, Counselor Medicare: Not Enrolled in Medicare Practice Location: 595 Forest Ave Ste 7and11a, Plymouth, MI 48170 Phone: 313-670-2207
William Kaczur, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1126 S Main St, Plymouth, MI 48170 Phone: 248-838-9220
Gail Baran Good, MSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 13896 Covington Dr, Plymouth, MI 48170 Phone: 248-420-9439
Melissa Martin, MA, LPC Counselor Medicare: Medicare Enrolled Practice Location: 600 N Evergreen St, Plymouth, MI 48170 Phone: 734-277-1810
Barbara Blom, LCSW, CAC Counselor Medicare: Accepting Medicare Assignments Practice Location: 477 S Main St, Plymouth, MI 48170 Phone: 734-416-3341

Tyler Lee Blackstock, LLPC CADC - Medicare Counselor in Plymouth, MI