Provider Demographics
NPI:1063020675
Name:TYLER FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:TYLER FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS, RPT
Authorized Official - Phone:903-363-3007
Mailing Address - Street 1:1910 ESE LOOP323 # 265
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8337
Mailing Address - Country:US
Mailing Address - Phone:903-402-3822
Mailing Address - Fax:
Practice Address - Street 1:515 W SOUTHWEST LOOP 323 STE 101
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9455
Practice Address - Country:US
Practice Address - Phone:903-402-3822
Practice Address - Fax:903-207-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3470858Medicaid