Individual provider · Type 1 NPI

Tyjuanique Revere

Mental Health Counselor · Detroit, MI

NPI number 1487551628 Active

Practice location

7800 W Outer Dr Ste LL04
Detroit, MI 48235-3461

Call (734) 255-4000 Map

Fax (313) 766-5882

Mailing address

5266 Oak Park Dr
Clarkston, MI 48346-3943

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X6451024033 (MI)

Mental Health Counselor: Definition to come...

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About NPI 1487551628

Tyjuanique Revere's National Provider Identifier is 1487551628, issued on Oct 21, 2026. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Detroit, MI. The record was last updated on Oct 21, 2026.