Provider Demographics
NPI:1831951250
Name:HILL, TYLER WALLACE (MFT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:WALLACE
Last Name:HILL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 CAZENOVIA RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9631
Mailing Address - Country:US
Mailing Address - Phone:607-426-0264
Mailing Address - Fax:
Practice Address - Street 1:8195 CAZENOVIA RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9631
Practice Address - Country:US
Practice Address - Phone:607-426-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist