Provider Demographics
NPI:1730498346
Name:TEDMON-JONES, TYLER S (LPC, LCAT, BC-DMT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:S
Last Name:TEDMON-JONES
Suffix:
Gender:M
Credentials:LPC, LCAT, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-8672
Mailing Address - Country:US
Mailing Address - Phone:412-760-2447
Mailing Address - Fax:718-388-2761
Practice Address - Street 1:507 S 4TH ST STE B-2
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3753
Practice Address - Country:US
Practice Address - Phone:917-671-8274
Practice Address - Fax:307-460-9084
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012361101YM0800X
NY001383-1225600000X
WYLPC-1664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist