Provider Demographics
NPI:1477039345
Name:TYLER, LENNON (PSYD)
Entity type:Individual
Prefix:DR
First Name:LENNON
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 ADVANTAGE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6736
Mailing Address - Country:US
Mailing Address - Phone:808-265-8303
Mailing Address - Fax:
Practice Address - Street 1:7609 ADVANTAGE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6736
Practice Address - Country:US
Practice Address - Phone:808-265-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-2196103T00000X
HI1868-15101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty