Provider Demographics
NPI:1437658366
Name:BRESHEARS, TYLER COLBY (LPC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:COLBY
Last Name:BRESHEARS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1410
Mailing Address - Country:US
Mailing Address - Phone:816-508-1700
Mailing Address - Fax:816-508-1757
Practice Address - Street 1:300 E 36TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1410
Practice Address - Country:US
Practice Address - Phone:816-508-1700
Practice Address - Fax:816-508-1757
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017038645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional