Provider Demographics
NPI:1407338379
Name:TYLER, HENRY MARSHAL (LPCC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:MARSHAL
Last Name:TYLER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 CANADA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2089
Mailing Address - Country:US
Mailing Address - Phone:928-499-4871
Mailing Address - Fax:
Practice Address - Street 1:2505 CANADA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2089
Practice Address - Country:US
Practice Address - Phone:928-499-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17011101Y00000X
CALPCC7234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC-7234OtherCA BOARD OF BEHAVIORAL SCIENCES
AZLPC-17011OtherAZ BOARD OF BEHAVIORAL HEALTH EXAMINERS