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NPI Code Detail

MEDICARE: CLAIRE C. TYLER MSW, LCSW

MEDICARE: CLAIRE C. TYLER MSW, 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 WorkerC6780MS

General Provider Information

NPI Number : 1902152937
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE C. TYLER MSW, LCSW
Provider Business Mailing Address
First Line : 1059 RIDGEWOOD PL
Second Line :
City : JACKSON
State : MS
Zip : 39211-2018
Country : US
Telephone Number : 601-957-3211
Fax Number : 601-957-9753
Provider Business Practice Location Address
First Line : 1059 RIDGEWOOD PL
Second Line :
City : JACKSON
State : MS
Zip : 39211-2018
Country : US
Telephone Number : 601-957-3211
Fax Number : 601-957-9753
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2012
Last Update Date : 07/27/2012

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