Provider Demographics
NPI:1235918392
Name:SPRANGER-ROON, TYLA MARIE
Entity Type:Individual
Prefix:
First Name:TYLA
Middle Name:MARIE
Last Name:SPRANGER-ROON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYLA
Other - Middle Name:MARIE
Other - Last Name:SPRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21358 NORDHOFF ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6918
Mailing Address - Country:US
Mailing Address - Phone:818-426-1373
Mailing Address - Fax:
Practice Address - Street 1:9017 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3989
Practice Address - Country:US
Practice Address - Phone:818-927-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist