Provider Demographics
NPI:1982184222
Name:KOLB, TYLER LEE (RBT, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:LEE
Last Name:KOLB
Suffix:
Gender:F
Credentials:RBT, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 LIHOLIHO ST APT 107
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2678
Mailing Address - Country:US
Mailing Address - Phone:732-814-0152
Mailing Address - Fax:
Practice Address - Street 1:427 ALA MAKANI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3571
Practice Address - Country:US
Practice Address - Phone:808-204-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3532190171400000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171400000XOther Service ProvidersHealth & Wellness Coach