Provider Demographics
NPI:1043860760
Name:HARVEY, TYLER REESE TURNER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:REESE TURNER
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S EL CAMINO REAL STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2382
Mailing Address - Country:US
Mailing Address - Phone:650-372-4080
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061
Practice Address - Country:US
Practice Address - Phone:650-839-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness