Provider Demographics
NPI:1932658846
Name:TYLER, KIMBERLY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DENISE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW-C
Mailing Address - Street 1:297 JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-3829
Mailing Address - Country:US
Mailing Address - Phone:207-263-6162
Mailing Address - Fax:
Practice Address - Street 1:297 JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:EAST MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04630-3829
Practice Address - Country:US
Practice Address - Phone:207-263-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor