Provider Demographics
NPI:1821801820
Name:SENVARDARLI, TYLIN (AMFT)
Entity type:Individual
Prefix:
First Name:TYLIN
Middle Name:
Last Name:SENVARDARLI
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11181 WILLOW VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8621
Mailing Address - Country:US
Mailing Address - Phone:214-632-0405
Mailing Address - Fax:
Practice Address - Street 1:11181 WILLOW VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8621
Practice Address - Country:US
Practice Address - Phone:214-632-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT152827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist