Provider Demographics
NPI:1518739085
Name:BURGER, TYLER (CADC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BURGER
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WELCH DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9476
Mailing Address - Country:US
Mailing Address - Phone:270-206-2629
Mailing Address - Fax:
Practice Address - Street 1:1250 OLD SOLDIER CREEK RD
Practice Address - Street 2:
Practice Address - City:KIRKSEY
Practice Address - State:KY
Practice Address - Zip Code:42054-9117
Practice Address - Country:US
Practice Address - Phone:270-489-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)