Provider Demographics
NPI:1447138474
Name:HEAD, TYLER-JAMES A
Entity type:Individual
Prefix:
First Name:TYLER-JAMES
Middle Name:A
Last Name:HEAD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1026
Mailing Address - Country:US
Mailing Address - Phone:517-213-5260
Mailing Address - Fax:
Practice Address - Street 1:25900 DEQUINDRE RD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-6107
Practice Address - Country:US
Practice Address - Phone:517-213-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical