Individual ProviderTyra Van Gilder LemmenSocial WorkerBehavioral Health & Social Service ProvidersPractice Address425 E Washington St, Suite 101-A, Ann Arbor, MI 48104-2024(734) 995-3042(734) 665-7245PECOS EnrollmentBased on the most recent information from CMS, provider Tyra Van Gilder Lemmen does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1932249182Provider TypeIndividualFull NameLemmen, Tyra Van GilderTitleMs.CredentialM.S.W.GenderFemaleSole ProprietorYesEnumeration Date2/7/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address425 E Washington St, Suite 101-A, Ann Arbor, MI 48104-2024Phone(734) 995-3042FaxUnlisted FaxMailing LocationMailing Address3122 Fairhaven Ct, Ann Arbor, MI 48105-9665Phone(734) 665-7245FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense6801035076MichiganProvider IdentifiersIDDescriptionIssuerID80-0-89-2292-0DescriptionOtherIssuerBC BS PIN OR CPCMichigan