Provider Demographics
NPI:1609135334
Name:NELSON, DYLAN TYLER (BA)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:TYLER
Last Name:NELSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 FERNDALE DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-6709
Mailing Address - Country:US
Mailing Address - Phone:816-215-9836
Mailing Address - Fax:
Practice Address - Street 1:453 FERNDALE DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-6709
Practice Address - Country:US
Practice Address - Phone:814-215-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor