Provider Demographics
NPI:1255647780
Name:TYLER, WESLEY ROBERT (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:ROBERT
Last Name:TYLER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361524
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1524
Mailing Address - Country:US
Mailing Address - Phone:321-952-5105
Mailing Address - Fax:
Practice Address - Street 1:540 MONTREAL AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7007
Practice Address - Country:US
Practice Address - Phone:321-952-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW97981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical