Provider Demographics
NPI:1942495015
Name:WASSON, TYLER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:WASSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 VALENCIA ST
Mailing Address - Street 2:APT. 11
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2309
Mailing Address - Country:US
Mailing Address - Phone:626-497-0768
Mailing Address - Fax:
Practice Address - Street 1:500 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4345
Practice Address - Country:US
Practice Address - Phone:408-554-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical