Provider Demographics
NPI:1396469136
Name:LEVY, TYLER RYAN
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:RYAN
Last Name:LEVY
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 1:1202 ANNAPOLIS RD STE F
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1387
Mailing Address - Country:US
Mailing Address - Phone:240-296-1370
Mailing Address - Fax:410-672-2869
Practice Address - Street 1:1202 ANNAPOLIS RD STE F
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1387
Practice Address - Country:US
Practice Address - Phone:240-296-1370
Practice Address - Fax:410-672-2869
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health