Provider Demographics
NPI:1932975554
Name:WEBER, TYLER ANDREW
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:ANDREW
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 S VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:PALERMO
Mailing Address - State:CA
Mailing Address - Zip Code:95968-9617
Mailing Address - Country:US
Mailing Address - Phone:530-424-8855
Mailing Address - Fax:
Practice Address - Street 1:1095 STAFFORD WAY STE J
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3333
Practice Address - Country:US
Practice Address - Phone:530-434-6318
Practice Address - Fax:530-763-5491
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty