Provider Demographics
NPI:1245750835
Name:TYLER, LORI LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:TYLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S BEECH ST STE B102
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3751
Mailing Address - Country:US
Mailing Address - Phone:970-946-1539
Mailing Address - Fax:719-638-8115
Practice Address - Street 1:23 S BEECH ST STE B102
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3751
Practice Address - Country:US
Practice Address - Phone:970-946-1539
Practice Address - Fax:719-638-8115
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-28971106E00000X
CO1-17-28971103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019696900Medicaid