Provider Demographics
NPI:1700228889
Name:TYLER, WILLIAM HARRY JR (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HARRY
Last Name:TYLER
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 BLYTHEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2384
Mailing Address - Country:US
Mailing Address - Phone:517-993-5474
Mailing Address - Fax:517-993-5476
Practice Address - Street 1:5925 BLYTHEFIELD AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-993-5474
Practice Address - Fax:517-993-5476
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist