Provider Demographics
NPI:1881720142
Name:TYLER, DIXIE L (MFT)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:L
Last Name:TYLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 TRIBUTE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4305
Mailing Address - Country:US
Mailing Address - Phone:916-924-6400
Mailing Address - Fax:916-648-0196
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5030395OtherAETNA
CAMFC20685OtherBLUE CROSS
CA1436131OtherPACIFICARE
CAMCMG382000OtherWESTERN HEALTH ADVANTAGE
CA5717866OtherFIRST HEALTH
CA000810824359OtherPHCS
CA1145588OtherGREAT WEST
CA257719OtherINTERPLAN