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NPI Code Detail

MEDICARE: MS. MARY LAWRENCE TYLER LCSW

MEDICARE: MS. MARY LAWRENCE TYLER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker3808-LCSWAZ

General Provider Information

NPI Number : 1003175118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY LAWRENCE TYLER LCSW
Provider Business Mailing Address
First Line : 1788 CAL YOUNG RD
Second Line : #185
City : EUGENE
State : OR
Zip : 97401-7638
Country : US
Telephone Number : 808-284-6053
Fax Number :
Provider Business Practice Location Address
First Line : 1788 CAL YOUNG RD
Second Line : #185
City : EUGENE
State : OR
Zip : 97401-7638
Country : US
Telephone Number : 808-284-6053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2012
Last Update Date : 05/09/2012

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