Provider Demographics
NPI:1073688842
Name:KYLES, TANYA C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:C
Last Name:KYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 CROSSBOW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2904
Mailing Address - Country:US
Mailing Address - Phone:706-596-5590
Mailing Address - Fax:
Practice Address - Street 1:6048 CROSSBOW DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2904
Practice Address - Country:US
Practice Address - Phone:706-596-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC4235101Y00000X
GANNC73246101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANCC73246Medicare UPIN
GALPC4235Medicare UPIN