Provider Demographics
NPI:1083956528
Name:HAYNES, TYLER J (MSW)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:J
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2214 DOGWOOD ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1338
Mailing Address - Country:US
Mailing Address - Phone:253-833-2790
Mailing Address - Fax:253-939-6018
Practice Address - Street 1:925 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5623
Practice Address - Country:US
Practice Address - Phone:253-833-2790
Practice Address - Fax:253-939-6018
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X, 1041C0700X
WA00217839 CPHQ174400000X
WAPS0141449 CPPS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program