Provider Demographics
NPI:1407300585
Name:TYLER, DONALD HAMILTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HAMILTON
Last Name:TYLER
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 1:500 E 33RD ST
Mailing Address - Street 2:APT 1802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 E 33RD ST
Practice Address - Street 2:APT 1802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4056
Practice Address - Country:US
Practice Address - Phone:773-573-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical