Provider Demographics
NPI:1316566458
Name:STRONG, TYLER JUSTICE
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JUSTICE
Last Name:STRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3630
Mailing Address - Country:US
Mailing Address - Phone:402-417-4003
Mailing Address - Fax:888-317-7322
Practice Address - Street 1:2000 P ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3630
Practice Address - Country:US
Practice Address - Phone:402-417-4003
Practice Address - Fax:888-317-7322
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE911104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty