Provider Demographics
NPI:1275019507
Name:TYLER PSYCHOLOGICAL SERVICES, L.L.C.
Entity Type:Organization
Organization Name:TYLER PSYCHOLOGICAL SERVICES, L.L.C.
Other - Org Name:KRISTEN TYLER PSYCHOTHERAPY, L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-714-7616
Mailing Address - Street 1:1010 LAKE ST STE 616
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST STE 616
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:708-714-7616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1881028603OtherBLUE CROSS BLUE SHIELD OF ILLINOIS