Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tyler Lee Blackstock, LLPCCADC

Individual provider Professional Counselor · NPI 1801439112

Tyler Lee Blackstock, LLPCCADC is a Mental Health Counselor in Plymouth, Michigan. Qualified in 2022, 4 years ago. Practices with Michigan Safe Space LLC, a 2-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
4
Licensed in
MI
In the registry since
2019

Practice location Address checks out

9401 N Haggerty Rd
Plymouth, MI 48170-4696
Phone: (734) 845-6010
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 6451022333 (MI)

Record details

NPI number1801439112
Entity typeIndividual (Type 1)
GenderMale
Credentials LLPCCADC
Sole proprietorNo
NPI enumeratedOctober 21, 2019
Last updated in NPPESMarch 13, 2023
Certification dateMarch 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Michigan Safe Space Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Plymouth