Provider Demographics
NPI:1578704862
Name:TYLER, ANNE (MS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 FARMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8441
Mailing Address - Country:US
Mailing Address - Phone:612-387-1797
Mailing Address - Fax:612-460-0915
Practice Address - Street 1:4500 PARK GLEN RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2605
Practice Address - Country:US
Practice Address - Phone:612-387-1797
Practice Address - Fax:612-460-0915
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1908106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist