Provider Demographics
NPI:1649281502
Name:WHITEHEAD, TYLER JAYE (MA)
Entity type:Individual
Prefix:MS
First Name:TYLER
Middle Name:JAYE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 FRYE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1116
Mailing Address - Country:US
Mailing Address - Phone:405-476-0881
Mailing Address - Fax:
Practice Address - Street 1:300 S RANCHWOOD BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2741
Practice Address - Country:US
Practice Address - Phone:405-476-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker