Provider Demographics
NPI:1235735788
Name:CHARLES, TYLER WILLIAM (M ED)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:WILLIAM
Last Name:CHARLES
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 HUDDERFIELD CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0654
Mailing Address - Country:US
Mailing Address - Phone:904-864-4532
Mailing Address - Fax:
Practice Address - Street 1:8700 ROLLING BROOK LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9024
Practice Address - Country:US
Practice Address - Phone:904-534-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst