Provider Demographics
NPI:1396880613
Name:TYLER, KRISTINA LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNNE
Last Name:TYLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26302 LA PAZ RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5328
Mailing Address - Country:US
Mailing Address - Phone:949-632-6166
Mailing Address - Fax:949-586-7470
Practice Address - Street 1:26302 LA PAZ RD STE 201
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5328
Practice Address - Country:US
Practice Address - Phone:949-632-6166
Practice Address - Fax:949-586-7470
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38684103T00000X
CA21771103T00000X
CAPSY 21771103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily