Provider Demographics
NPI:1275924284
Name:HALFORD, TYLER (PHD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HALFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 CODY DR
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3443
Mailing Address - Country:US
Mailing Address - Phone:775-742-2010
Mailing Address - Fax:
Practice Address - Street 1:314 N LAST CHANCE GULCH STE 204
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5012
Practice Address - Country:US
Practice Address - Phone:775-742-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MTPSY-LIC-3546103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program