Provider Demographics
NPI:1174688634
Name:TYCOLIZ CAMPBELL, DEBORHA (PSY S LLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORHA
Middle Name:
Last Name:TYCOLIZ CAMPBELL
Suffix:
Gender:F
Credentials:PSY S LLP
Other - Prefix:
Other - First Name:DEBORHA
Other - Middle Name:TYCOLIZ
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1094 FOREST BAY DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4284
Mailing Address - Country:US
Mailing Address - Phone:248-210-3574
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 312
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-922-2300
Practice Address - Fax:248-922-2304
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist