Provider Demographics
NPI:1023585502
Name:MCCARTHY, TRYSTYN (MA, TLLP)
Entity type:Individual
Prefix:MRS
First Name:TRYSTYN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1584
Mailing Address - Country:US
Mailing Address - Phone:248-924-1070
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1584
Practice Address - Country:US
Practice Address - Phone:248-924-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017623103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling