Provider Demographics
NPI:1952929705
Name:TYLER, ANGELA RENAE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENAE
Last Name:TYLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENAE
Other - Last Name:STILLWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT 781625
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1625
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:
Practice Address - Street 1:495 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5349
Practice Address - Country:US
Practice Address - Phone:614-980-9811
Practice Address - Fax:614-355-8056
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0030951104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker