Provider Demographics
NPI:1043998024
Name:TYLER, CHRISTOPHER R
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:TYLER
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 1:327 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5835
Mailing Address - Country:US
Mailing Address - Phone:504-450-8063
Mailing Address - Fax:
Practice Address - Street 1:824 ELMWOOD PARK BLVD STE 135
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3337
Practice Address - Country:US
Practice Address - Phone:504-266-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health