Provider Demographics
NPI:1013442300
Name:CREW, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MCKEEN PL APT 603
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4439
Mailing Address - Country:US
Mailing Address - Phone:318-623-5474
Mailing Address - Fax:
Practice Address - Street 1:1501 MCKEEN PL APT 603
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4439
Practice Address - Country:US
Practice Address - Phone:318-623-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician