Provider Demographics
NPI:1821592247
Name:MABRY, TYLER PAIGE (LCPC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:PAIGE
Last Name:MABRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9845 SOLAR CRSE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6802
Mailing Address - Country:US
Mailing Address - Phone:240-786-2185
Mailing Address - Fax:
Practice Address - Street 1:531 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4126
Practice Address - Country:US
Practice Address - Phone:240-451-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health