Provider Demographics
NPI:1265110191
Name:BERRY, TYLER FLEMING (BCBA/LBA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:FLEMING
Last Name:BERRY
Suffix:
Gender:F
Credentials:BCBA/LBA
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:CATHERINE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4268
Mailing Address - Country:US
Mailing Address - Phone:540-949-7045
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4268
Practice Address - Country:US
Practice Address - Phone:540-949-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003085103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst