Provider Demographics
NPI:1043415763
Name:TYLER, RICHARD EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:TYLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 STARMONT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2931
Mailing Address - Country:US
Mailing Address - Phone:919-383-3168
Mailing Address - Fax:
Practice Address - Street 1:7312 CAMUS
Practice Address - Street 2:NC STATE UNIVERSITY
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-7312
Practice Address - Country:US
Practice Address - Phone:919-513-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional