Healthcare Provider Details

I. General information

NPI: 1811237555
Provider Name (Legal Business Name): PATRICIA ANN TYLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 AVALON BLVD STE 116
CARSON CA
90746-3728
US

IV. Provider business mailing address

20700 AVALON BLVD STE 116
CARSON CA
90746-3728
US

V. Phone/Fax

Practice location:
  • Phone: 323-446-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW133452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW126389
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW86490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: