Healthcare Provider Details

I. General information

NPI: 1396880613
Provider Name (Legal Business Name): KRISTINA LYNNE TYLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD STE 201
MISSION VIEJO CA
92691-5328
US

IV. Provider business mailing address

26302 LA PAZ RD STE 201
MISSION VIEJO CA
92691-5328
US

V. Phone/Fax

Practice location:
  • Phone: 949-632-6166
  • Fax: 949-586-7470
Mailing address:
  • Phone: 949-632-6166
  • Fax: 949-586-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number38684
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number21771
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 21771
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 21771
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 21771
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 21771
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 21771
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY 21771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: