Provider Demographics
NPI:1205512407
Name:TYLER, JUWAN LAMONT
Entity type:Individual
Prefix:
First Name:JUWAN
Middle Name:LAMONT
Last Name:TYLER
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 1:1240 E BROOMFIELD ST APT CC4
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7009
Mailing Address - Country:US
Mailing Address - Phone:313-646-1024
Mailing Address - Fax:
Practice Address - Street 1:1395 N MCEWAN ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-1111
Practice Address - Country:US
Practice Address - Phone:989-286-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician