Provider Demographics
NPI:1013383561
Name:WOODY, TYLER G (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:G
Last Name:WOODY
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2627 REDWING RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-658-1007
Mailing Address - Fax:855-670-0384
Practice Address - Street 1:2627 REDWING RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-658-1007
Practice Address - Fax:855-670-0384
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.00178104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional