Provider Demographics
NPI:1629796909
Name:WALKER, TYLER ILYSSE
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ILYSSE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 ENGLISH COTTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-7473
Mailing Address - Country:US
Mailing Address - Phone:305-968-9276
Mailing Address - Fax:
Practice Address - Street 1:3064 ENGLISH COTTAGE WAY
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7473
Practice Address - Country:US
Practice Address - Phone:305-968-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician