Provider Demographics
NPI:1427573179
Name:NASH, TYLER ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:ALEXANDER
Last Name:NASH
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 1:1065 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3027
Mailing Address - Country:US
Mailing Address - Phone:805-652-0029
Mailing Address - Fax:805-652-1490
Practice Address - Street 1:1065 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3027
Practice Address - Country:US
Practice Address - Phone:805-652-0029
Practice Address - Fax:805-652-1490
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAASW1199081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)