Provider Demographics
NPI:1598221574
Name:TYLER, KRYSTAL (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 W CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9268
Mailing Address - Country:US
Mailing Address - Phone:662-494-1530
Mailing Address - Fax:
Practice Address - Street 1:405 LYNN LN
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-4412
Practice Address - Country:US
Practice Address - Phone:662-228-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2022-03-30
Deactivation Date:2020-09-29
Deactivation Code:
Reactivation Date:2022-03-30
Provider Licenses
StateLicense IDTaxonomies
MSC81751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical