Provider Demographics
NPI:1083066781
Name:TYL MENTAL HEALTH IN HOME SERVICES
Entity Type:Organization
Organization Name:TYL MENTAL HEALTH IN HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-646-7561
Mailing Address - Street 1:13800 HEACOCK ST STE 116
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:951-247-3504
Practice Address - Street 1:13800 HEACOCK ST STE 116
Practice Address - Street 2:19355 REDROCK ST PERRIS,CA 92570
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8810
Practice Address - Country:US
Practice Address - Phone:323-646-7561
Practice Address - Fax:951-247-3504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYL MENTAL HEALTH IN HOME SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health