Provider Demographics
NPI:1922996057
Name:BONIAL, TYLER (CIT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BONIAL
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-9366
Mailing Address - Country:US
Mailing Address - Phone:318-600-3333
Mailing Address - Fax:318-600-3334
Practice Address - Street 1:2321 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-9366
Practice Address - Country:US
Practice Address - Phone:318-600-3333
Practice Address - Fax:318-600-3334
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5978101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)