Provider Demographics
NPI:1073536249
Name:TYLER, JOAN (MFT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 N 8TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2336
Mailing Address - Country:US
Mailing Address - Phone:760-352-6302
Mailing Address - Fax:
Practice Address - Street 1:380 N 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2336
Practice Address - Country:US
Practice Address - Phone:760-352-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist