Healthcare Provider Details

I. General information

NPI: 1194134163
Provider Name (Legal Business Name): TYE KILLIAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 GOVERNMENT BLVD STE 203
MOBILE AL
36693-4310
US

IV. Provider business mailing address

3737 GOVERNMENT BLVD STE 203
MOBILE AL
36693-4310
US

V. Phone/Fax

Practice location:
  • Phone: 251-300-7134
  • Fax: 251-202-7851
Mailing address:
  • Phone: 251-300-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6462C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-37070
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: