Tyler Lee Blackstock, LLPC. CADC
NPI 1801439112ActiveIndividual· Counselor, Professional· Plymouth, MI
Counselor, Professional (LLPC. CADC) with Michigan Safe Space LLC, practicing in Plymouth, Michigan. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1801439112 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LLPC. CADC |
| Sole proprietor | No |
| NPI issued | Oct 21, 2019 |
| Last updated in NPPES | Mar 13, 2023 |
| Certified by provider | Mar 13, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Professional Primary | 101YP2500X | 6451022333 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (MI) |
|---|
Education and affiliations
| Graduation year | 2022 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Michigan Safe Space LLCPlymouth, MI · 2 clinicians
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