Provider Demographics
NPI:1497131627
Name:HEBERT, TYLER PAUL (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:PAUL
Last Name:HEBERT
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5829
Mailing Address - Country:US
Mailing Address - Phone:318-255-5020
Mailing Address - Fax:
Practice Address - Street 1:3501 PATRICK ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1717
Practice Address - Country:US
Practice Address - Phone:337-263-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMFT 1171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720479Medicaid