Provider Demographics
NPI:1801598958
Name:MELVIN, TYLER (LPC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:MELVIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 EXPEDITION DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2084
Mailing Address - Country:US
Mailing Address - Phone:706-814-8526
Mailing Address - Fax:
Practice Address - Street 1:601 N BELAIR SQ STE 28
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4325
Practice Address - Country:US
Practice Address - Phone:706-810-2057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health