Provider Demographics
NPI:1679844542
Name:TYLER, SANDRA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:TYLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 N MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-3049
Mailing Address - Country:US
Mailing Address - Phone:405-365-0243
Mailing Address - Fax:
Practice Address - Street 1:6051 N BROOKLINE AVE STE 108
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4286
Practice Address - Country:US
Practice Address - Phone:405-607-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6540101Y00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator