Healthcare Provider Details

I. General information

NPI: 1124942016
Provider Name (Legal Business Name): TYLER MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3969 E ARAPAHOE RD STE 108
CENTENNIAL CO
80122-2003
US

IV. Provider business mailing address

7896 S KEARNEY CT
CENTENNIAL CO
80112-2443
US

V. Phone/Fax

Practice location:
  • Phone: 720-435-0147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: