Provider Demographics
NPI:1811750060
Name:FOREHAND, TYLER GLENN (LPC-A)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:GLENN
Last Name:FOREHAND
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 CASCADES BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709-5428
Mailing Address - Country:US
Mailing Address - Phone:903-787-0572
Mailing Address - Fax:
Practice Address - Street 1:4573 CASCADES BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75709-5428
Practice Address - Country:US
Practice Address - Phone:903-787-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional