Provider Demographics
NPI:1114473865
Name:TYLER, TIRANY
Entity Type:Individual
Prefix:
First Name:TIRANY
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MCKNIGHT DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7050
Mailing Address - Country:US
Mailing Address - Phone:800-420-8301
Mailing Address - Fax:800-480-5850
Practice Address - Street 1:502 MCKNIGHT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7050
Practice Address - Country:US
Practice Address - Phone:800-420-8301
Practice Address - Fax:800-480-5850
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical