Provider Demographics
NPI:1891005039
Name:NEAL, TYLER SCOTT (MSW)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:NEAL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97327-2015
Mailing Address - Country:US
Mailing Address - Phone:541-990-8815
Mailing Address - Fax:
Practice Address - Street 1:425 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2482
Practice Address - Country:US
Practice Address - Phone:541-990-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL82391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664296Medicaid