Provider Demographics
NPI:1457368821
Name:TYLER, DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 LONAS DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3250
Mailing Address - Country:US
Mailing Address - Phone:865-588-7132
Mailing Address - Fax:865-558-5967
Practice Address - Street 1:5516 LONAS DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3250
Practice Address - Country:US
Practice Address - Phone:865-588-7132
Practice Address - Fax:865-558-5967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1684103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685422Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER