Provider Demographics
NPI:1235736190
Name:TYLER DAVIS LLC
Entity Type:Organization
Organization Name:TYLER DAVIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-341-5677
Mailing Address - Street 1:8607 N 59TH AVE SUITE C-6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302
Mailing Address - Country:US
Mailing Address - Phone:602-753-8040
Mailing Address - Fax:623-748-9220
Practice Address - Street 1:8607 N 59TH AVE SUITE C-6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302
Practice Address - Country:US
Practice Address - Phone:602-753-8040
Practice Address - Fax:623-748-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty