MEDICARE: TYRONE LAMONT TYLER II

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1700304243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE LAMONT TYLER II

Provider Business Mailing Address
First Line	:	511 N LAMB BLVD APT 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3362
Country	:	US
Telephone Number	:	505-692-8641
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 N LAMB BLVD APT 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3362
Country	:	US
Telephone Number	:	505-692-8641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	07/21/2022

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