Provider Demographics
NPI:1477931210
Name:TYLER, SELENA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 S LAKELINE BLVD
Mailing Address - Street 2:432
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3939
Mailing Address - Country:US
Mailing Address - Phone:512-785-5556
Mailing Address - Fax:
Practice Address - Street 1:2101 S LAKELINE BLVD
Practice Address - Street 2:432
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3939
Practice Address - Country:US
Practice Address - Phone:512-785-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional