Provider Demographics
NPI:1225428709
Name:TYLER, JESSICA MELENDEZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MELENDEZ
Last Name:TYLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 1ST AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-4276
Mailing Address - Country:US
Mailing Address - Phone:706-887-6464
Mailing Address - Fax:706-887-6565
Practice Address - Street 1:1214 1ST AVE STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-4276
Practice Address - Country:US
Practice Address - Phone:706-566-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3118101YP2500X
GALPC009063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional