Provider Demographics
NPI:1659483840
Name:TYLER COUNSELING & ASSESSMENT CENTER
Entity Type:Organization
Organization Name:TYLER COUNSELING & ASSESSMENT CENTER
Other - Org Name:TYLER COUNSELING & ASSESSMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:903-581-0933
Mailing Address - Street 1:1121 E SOUTHEAST LOOP 323
Mailing Address - Street 2:STE.204
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9660
Mailing Address - Country:US
Mailing Address - Phone:903-581-0933
Mailing Address - Fax:903-581-3977
Practice Address - Street 1:1121 E SOUTHEAST LOOP 323
Practice Address - Street 2:STE.204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9660
Practice Address - Country:US
Practice Address - Phone:903-581-0933
Practice Address - Fax:903-581-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080723201Medicaid
TX080723201Medicaid