Provider Demographics
NPI:1184341794
Name:TYLER, YESENIA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3637 VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-1561
Mailing Address - Country:US
Mailing Address - Phone:323-787-3436
Mailing Address - Fax:
Practice Address - Street 1:3637 VENTURA AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-1561
Practice Address - Country:US
Practice Address - Phone:323-787-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker