Provider Demographics
NPI:1437468329
Name:STAHL, TYLER J (MA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:STAHL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 BOYLSTON AVE E APT 4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4627
Mailing Address - Country:US
Mailing Address - Phone:206-402-1346
Mailing Address - Fax:
Practice Address - Street 1:752 BOYLSTON AVE E APT 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4627
Practice Address - Country:US
Practice Address - Phone:206-402-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60148856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health