Provider Demographics
NPI:1881495398
Name:EVANS, TYLER NICOLE (BA,MA,PPS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:BA,MA,PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24585 TOWN CENTER DR APT 4104
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1387
Mailing Address - Country:US
Mailing Address - Phone:626-272-5111
Mailing Address - Fax:
Practice Address - Street 1:5927 CANTALOUPE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4313
Practice Address - Country:US
Practice Address - Phone:818-245-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18378101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor