1689673824 NPI number — MR. STEVEN TYLER LCSW

Table of content: MR. STEVEN TYLER LCSW (NPI 1689673824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689673824 NPI number — MR. STEVEN TYLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689673824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9615 E 148TH ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
NOBLESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46060-4360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-587-0500
Provider Business Mailing Address Fax Number:
317-674-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 RANSDELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46052-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-482-7100
Provider Business Practice Location Address Fax Number:
317-674-0059
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34001489A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100073590 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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