Provider Demographics
NPI:1578868170
Name:ROUSSEAU, TYLER EVAN
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:EVAN
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NEW SOUTH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4075
Mailing Address - Country:US
Mailing Address - Phone:413-582-0471
Mailing Address - Fax:413-582-1807
Practice Address - Street 1:17 NEW SOUTH ST STE 116
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4075
Practice Address - Country:US
Practice Address - Phone:413-582-0471
Practice Address - Fax:413-582-1807
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor