Provider Demographics
NPI:1982487906
Name:TYLER, ROBERT (LCSW, CCM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:LCSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 MASSEY TOMPKINS RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2837
Mailing Address - Country:US
Mailing Address - Phone:717-318-8398
Mailing Address - Fax:
Practice Address - Street 1:3302 MASSEY TOMPKINS RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2837
Practice Address - Country:US
Practice Address - Phone:717-318-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX689511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical