Provider Demographics
NPI:1841388055
Name:TYLER, LORI ANN (PHD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:TYLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12724 WHITTIER BLVD
Mailing Address - Street 2:#A8
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2900
Mailing Address - Country:US
Mailing Address - Phone:562-945-7600
Mailing Address - Fax:
Practice Address - Street 1:12724 WHITTIER BLVD
Practice Address - Street 2:#A8
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2900
Practice Address - Country:US
Practice Address - Phone:562-945-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20342103TC0700X
CAPSY 20342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY20342OtherLICENSE NUMBER