Provider Demographics
NPI:1356799597
Name:TYLER, STEPHANIE NICOLE
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 OLD COLUMBIA RD
Mailing Address - Street 2:STE L260
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1702
Mailing Address - Country:US
Mailing Address - Phone:443-259-0400
Mailing Address - Fax:443-259-0044
Practice Address - Street 1:10005 OLD COLUMBIA RD
Practice Address - Street 2:STE L260
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1702
Practice Address - Country:US
Practice Address - Phone:443-259-0400
Practice Address - Fax:443-259-0044
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional